Predictors of Sudden Cardiac Death
Open Access
- 1 January 2012
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 7 (1), 123-130
- https://doi.org/10.2215/cjn.06320611
Abstract
Background and objectives There are few data on risk factors for sudden cardiac death (SCD) in patients undergoing hemodialysis (HD). The study objective was to identify predictors associated with various causes of death in the Hemodialysis (HEMO) Study and to develop a prediction model for SCD using a competing risk approach. Design, setting, participants, & measurements In this analysis of 1745 HEMO participants, all-cause mortality was classified as SCD, non-SCD, and noncardiac death. Predictors for each cause of death were evaluated using cause-specific Cox proportional hazards models, and a competing risk approach was used to calculate absolute risk predictions for SCD. Results During a median follow-up of 2.5 years, 808 patients died. Rates of SCD, non-SCD, and noncardiac death were 22%, 17%, and 61%, respectively. Predictors of various causes of death differ somewhat in HD patients. Age, diabetes, peripheral vascular disease, ischemic heart disease, serum creatinine, and alkaline phosphatase were independent predictors of SCD. The 3-year C-statistic for SCD was 0.75 (95% confidence interval, 0.70–0.79), and calibration was good (χ2=1.1; P=0.89). At years 3 and 5 of follow-up, the standard Cox model overestimated the risk for SCD as compared with the competing risk approach on the relative scale by 25% and 46%, respectively, and on the absolute scale by 2% and 6%, respectively. Conclusions Predictors of various causes of death differ in HD patients. The proposed prediction model for SCD accounts for competing causes of death. External validation of this model is required.Keywords
This publication has 40 references indexed in Scilit:
- Sudden Cardiac Death in Hemodialysis Patients: An In-Depth ReviewAmerican Journal of Kidney Diseases, 2011
- Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinicsKidney International, 2011
- Prognostic Models With Competing RisksEpidemiology, 2009
- Predicting the 30-Year Risk of Cardiovascular DiseaseCirculation, 2009
- Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance HemodialysisClinical Journal of the American Society of Nephrology, 2009
- NON‐CORONARY HEART DISEASE IN DIALYSIS PATIENTS: Sudden Cardiac Death and Dialysis PatientsSeminars in Dialysis, 2008
- Upregulation of alkaline phosphatase and pyrophosphate hydrolysis: Potential mechanism for uremic vascular calcificationKidney International, 2008
- Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis PatientsJournal of Renal Nutrition, 2007
- Cardiac arrest in dialysis patients: Approaches to alter an abysmal outcomeKidney International, 2003
- Comorbidity assessment using the Index of Coexistent Diseases in a multicenter clinical trialKidney International, 2001