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Clinical Articles

Reducing sudden cardiac death in dialysis patients

Mortality in dialysis patients is extremely high, with an annual death rate of ~ 23%. Sudden cardiac death (SCD) is the single largest cause of death in dialysis patients accounting for ~ 60% of all cardiac deaths and 25% of all-cause mortality. The current status of medical and device interventions is reviewed in a comprehensive publication in the European Heart Journal. [1]

Currently in the US some 350 000 patients are treated with dialysis, a figure estimated to increase to over half a million by 2020. In Europe too the number of dialysis patients is increasing annually. Their mortality is very high, at about 23% per year.

Interventions aiming at reducing cardiovascular mortality, especially SCD, in dialysis patients are therefore extremely important and clinically highly relevant. Dr MK de Bie and colleagues from the Netherlands review this topic and outline the epidemiology of SCD in dialysis patients, and provide a comprehensive overview of conventional and future interventional strategies (medical therapies eg beta blockers, statins and erythropoietin, as well as changing dialysis modality, and revascularization). This highly recommended review also looks at the current knowledge regarding the value of preventive cardioverter defibrillator (ICD) implantation and addresses future implications of these interventional strategies.

Despite successes shown in observational studies, the potential benefits of ICD treatment have not yet been evaluated prospectively in dialysis patients, the authors say. A prospective trial is warranted, and they outline details of their on-going, Implantable Cardioverter Defibrillator in Dialysis patients (ICD2) study (de Bie et al. Curr Med Res Opin 2008;24:2151-2157).

Forthcoming cardio-renal conference

For those interested in the co-morbid problems of renal and cardiovascular patients, a conference is being organized at the Royal College of Physicians (RCP) of London on 21st September this year. ‘Optimising care at the cardio-renal interface’ will provide a stimulating overview of issues including ‘Sudden cardiac death in advanced CKD’ , by Dr Paul Roberts, Consultant Cardiologist, Southampton General Hospital.

Attendance at this joint conference of the RCP, British Cardiovascular Society, the Renal Association, in association with the Cardiorenal Forum, merits 6 CPD credits. Full details of the meeting can be found on, www.cardiorenalforum.com, or www.rcplondon.ac.uk. The Arrhythmia Watch team hope to see you there!

Reference

  1. de Bie MK, van Dam B, Gaasbeek A, van Buren, M et al. The current status of interventions aiming at reducing sudden cardiac death in dialysis patients. Eur Heart J 2009;30:1559-1564.

Published on: July 22, 2009

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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