Sudden cardiac arrest in chronic kidney disease

Chronic kidney disease (CKD) is a worldwide health problem with increasing incidence, prevalence, morbidity, and mortality. Death from cardiovascular disease in general and sudden cardiac arrest (SCA) in particular are exponentially proportional to declining renal function and are a major cause of mortality among all those with CKD. The greatest risk however is reserved for patients with end-stage renal disease (ESRD) on chronic dialysis. These individuals have an extraordinarily high mortality with an annual death rate of 221 deaths per 1,000 patient-years. Cardiac disease is the major cause of death in these patients, accounting for 45 % of all-cause mortality regardless of the mode of dialysis. Of these, 60 % appear to be due to SCA, making this single diagnosis responsible for a quarter of all-cause mortality. Once cardiac arrest occurs in this group of patients, survival is poor. Even if the arrest occurred in the controlled setting of a dialysis unit, the majority will have died within 48 h and the 6-month survival rate among those dialysis patients successfully resuscitated is dismal. Thus, reducing mortality from cardiovascular disease among ESRD patients, including those due to SCA from arrhythmic events, is a global health challenge. The main objectives of this chapter are to elucidate the nature of SCA in the kidney diseases population, describe possible mechanisms and risk factors, and discuss options for prevention.