The Incidence and Associated Factors of Sudden Death in Patients on Hemodialysis: 10-Year Outcome of the Q-Cohort Study
Open Access
- 1 January 2020
- journal article
- research article
- Published by Japan Atherosclerosis Society in Journal of Atherosclerosis and Thrombosis
- Vol. 27 (4), 306-318
- https://doi.org/10.5551/jat.49833
Abstract
Aim: The incidence of sudden death and its risk factors in patients on hemodialysis remain unclear. This study aimed to clarify the incidence of sudden death and its risk factors in Japanese patients on hemodialysis. Methods: A total of 3505 patients on hemodialysis aged 18 years were followed for 10 years. Multivariate-adjusted hazard ratio (HR) with 95% confidence interval (95% CI) of each risk factor of sudden death were calculated using a Cox proportional hazards model. Results: During the 10-year follow-up, 1735 patients died, including 227 (13%) sudden deaths. The incidence rate of sudden death was 9.13 per 1000 person-years. In multivariable-adjusted Cox analysis, male sex (HR 1.67; 95% CI 1.20-2.33), age (HR 1.44; 95% CI 1.26-1.65 per 10-year higher), the presence of diabetes (HR 2.45; 95% CI 1.82-3.29), history of cardiovascular disease (HR 1.85; 95% CI 1.38-2.46), cardiothoracic ratio (HR 1.21; 95% CI 1.07-1.39 per 5% higher), serum C-reactive protein (HR 1.11; 95% CI 1.03-1.20 per 1-mg/dL higher), and serum phosphate (HR 1.15; 95% CI 1.03-1.30 per 1-mg/dL higher) were independent predictors of sudden death. A subgroup analysis stratified by sex or age showed that lower serum corrected calcium levels, not using vitamin D receptor activators in women, and a shorter dialysis session length in men or older people (>= 65 years) increased the risk for sudden death. Conclusions: This study clarified the incidence of sudden death and its specific predictors in Japanese patients on hemodialysis.This publication has 52 references indexed in Scilit:
- High Expression of the Pi-Transporter SLC20A1/Pit1 in Calcific Aortic Valve Disease Promotes Mineralization through Regulation of Akt-1PLOS ONE, 2013
- Modifiable Practices Associated with Sudden Death among Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns StudyClinical Journal of the American Society of Nephrology, 2012
- Trends in sudden cardiac death and its risk factors in Japan from 1981 to 2005: the Circulatory Risk in Communities Study (CIRCS)BMJ Open, 2012
- Risks of Subsequent Hospitalization and Death in Patients with Kidney DiseaseClinical Journal of the American Society of Nephrology, 2012
- Predictors of Sudden Cardiac DeathClinical Journal of the American Society of Nephrology, 2012
- Vitamin D, Parathyroid Hormone, and Sudden Cardiac DeathHypertension, 2011
- FGF23 induces left ventricular hypertrophyJCI Insight, 2011
- Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortalityKidney International, 2011
- Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patientsEuropean Heart Journal, 2010
- Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery diseaseKidney International, 2009