26% end stage renal disease ESRD sudden cardiac death SCD

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1 % QT Sudden death in patients with hemodialysis LI Chuan GONG De-hua Research Institute of Nephrology Jingling Hospital Nanjing University School of Medicine Nanjing China ABSTRACT The dialysis patients have extraordinarily high mortality rates. Cardiovascular causes are the major causes of death accounting for 43% of all-cause mortality among the patients with hemodialysis. In addition to increased traditional risk factors hemodialysis patients also have a number of nontraditional cardiovascular risk factors such as left ventricular hypertrophy coronary artery disease rapid electrolyte shifts QT dispersion sympathetic overactivity and calcium-phosphate deposition. The purpose of the present article is to critically review the current literature to summarize the following aspects 1 the pathophysiological mechanism responsible and 2 the prevention and management for the sudden death in patients with hemodialysis. Key words hemodialysis sudden death prevention MHD 43% Wanner 3 2 MHD 1 8% P = < 1h 9% 35% 24h 26% 2 MHD end stage renal disease ESRD sudden cardiac death SCD heart failure HF MHD MHD left ventricular hypertrophy LVH 4 LVH MHD LVH HF

2 476 J Nephrol Dialy Transplant Vol. 20 No. 5 Oct SCD MHD heart rate variability HRV HRV MHD HRV 9 Hayano 2 HRV MHD vascular endothelial growth factor VEGF HRV HD MHD 3 ESRD / 4h / - MHD 6 / 8 ~ 10 h / - 5 HRV SCD Chan 10 MHD MHD QT QT 12 QT QT QT LVH MHD QT SCD QT QT > 74 ms renin-angiotensinaldosterone system RAAS 6 QT K + Ⅱ angiotensin Ⅱ Ang Ⅱ K + 11 ESRD RAAS QT Genovesi 7 QT QT 12 QT QT ESRD congestive heart failure CHF MHD 8 β 1 β

3 QT Parekh QT MHD Karnik 17 C CRP 6 IL-6 2 Bleyer 16 13% MHD < 3. 5 meq /L 1h QT MHD Santoro 18 MHD renalase MHD β β MHD meq /L USRDS MHD 2 93 /1 000 MHD 5 β β 164 / MHD / % HRV CKD 15 ESRD β SCD HF 3 SCD 50% 16 12h 3 12h 19 renalase β SCD MHD 0 ~ 2. 5 mmol /L β β MHD

4 478 J Nephrol Dialy Transplant Vol. 20 No. 5 Oct coronary heart disease CHD CKD 20 β Lehrich 27 CHD β automated external CHD SCD defibrillator AED β implantable Pun cardioverter defibrillators ICD 21 β ICD β 24h 24h ICD MHD SCD β Cice 22 CKD HF MHD ICD ICD 2 6 β CKD ICD ESRD ICD ESRD Dasgupta 28 β CKD 23 ICD ESRD ACEI 29% 5% ARB ACEI P < logistic ESRD MHD ESRD MHD HF ICD ACEI ESRD HRV Efrati Amin 29 ICD 24 ACEI 52% CKD 1 2 ICD MHD CKD 25 ARB MHD MHD < 65 CKD 5 3 ICD 65 ~ Pun CKD 5 75 ~ CKD 3 ICD ACEI /ARB CKD ICD 6 ACEI /ARB MHD CKD 61. 2% 96. 3% 30 COX the national kidney CKD foundation dialysis outcome quality initiative NKF- CKD DOQI 10 ml /min 55%

5 ICD CKD CKD Robin 31 9 Johansson M ICD Herzog % ICD ICD Kidney Int ICD ICD 42% Heart Circ Physiol 2007 ICD SCD 12 Raizada V Skipper B ICD MHD SCD MHD PO 4 Ca PO 4 product ESRD Parekh RS Plantinga LC Kao WH Kidney Int ACEI /ARB ICD ESRD 1 US renal data system USRDS 2005 annual data report. National institutes of health national institute of diabetes and digestive and kidney diseases Bethesta MD Hayano J Takahashi H Toriyama T et al. Prognostic value of heart rate variability during long-term follow-up in chronic haemodialysis patients with endstage renal disease. Nephrol Dial Transplant Wanner C Krane V M rz W et al. German Diabetes and Dialysis Study Investigators Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med Remppis A Ritz E. Cardiac problems in the dialysis patient beyond coronary disease. Semin Dial Bleyer AJ Hartman J Brannon PC et al. Characteristics of sudden death in hemodialysis patients. Kidney Int Beaubien ER Pylypchuk GB Akhtar J et al. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis Genovesi S Dossi C Viganò MR et al. Electrolyte concentration during haemodialysis and QT interval prolongation in uraemic patients. Europace Zoccali C Mallamaci F Parlongo S et al. Plasma norepinephrine predicts survival and incident cardiovascular events in patients with endstage renal disease. Circulation Gao SA Friberg P et al. Baroreflex effectiveness index and baroreflex sensitivity predict all-cause mortality and sudden death in hypertensive patients with chronic renal failure. J Hypertens Chan CT Hanly P Gabor J et al. Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep Fischer R Dechend R Gapelyuk A et al. Angiotensin II-induced sudden arrhythmic death and electrical remodeling. Am J Physiol H H1253. Luo W et al. Renin-angiotensin polymorphisms and QTc interval prolongation in end-stage renal disease. Kidney Int Ganesh SK Stack AG Levin NW et al. Association of elevated serum and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol et al. The association of sudden cardiac death with inflammation and other traditional risk factors. 15 US renal data system USRDS 2006 annual data report Atlas of endstage renal disease in the United States. National institutes of health national institute of diabetes and digestive and kidney disease Bethesda MD Bleyer AJ Russell GB Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int Karnik JA Young BS Lew NL et al. Cardiac arrest and sudden death in dialysis units. Kidney Int Santoro A Mancini E London G et al. Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrol Dial Transplant Hausberg M Kosch M Harmelink P et al. Sympathetic nerve activity in endstage renal disease. Circulation Circulation Chonchol M Benderly M Goldbourt U. Beta-blockers for coronary heart disease in chronic kidney disease. Nephrol Dial Transplant Pun PH Lehrich RW Smith SR et al. Predictors of survival after cardiac arrest in outpatient hemodialysis clinics. Clin J Am Soc Nephrol Cice G Ferrara L D'Andrea A et al. Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy a prospective placebo-controlled trial J Am Coll Cardiol Kalaitzidis R Bakris G. Should nephrologists use beta-blockers A perspective Nephrol Dial Transplant Efrati S Zaidenstein R Dishy V et al. ACE inhibitors and survival of

6 480 J Nephrol Dialy Transplant Vol. 20 No. 5 Oct hemodialysis patients. Am J Kidney Dis Zannad F Kessler M Lehert P et al. Prevention of cardiovascular events in end-stage renal disease results of a randomized trial of fosinopril and implications for future studies. Kidney Int Takahashi A Takase H Toriyama T et al. Candesartan angiotensin II type-1 receptor blocker reduces cardiovascular events in patients on chronic haemodialysis-a randomized study. Nephrol Dial Transplant Lehrich RW Pun PH Tanenbaum ND et al. Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic. J Am Soc Nephrol Dasgupta A Montalvo J Medendorp S et al. Increased complication rates of cardiac rhythm management devices in ESRD patients. Am J Kidney Dis Amin MS Fox AD Kalahasty G et al. Benefit of primary prevention implantable cardioverter-defibrillators in the setting of chronic kidney disease a decision model analysis. J Cardiovasc Electrophysiol Cuculich PS Sánchez JM Kerzner R et al. Poor prognosis for patients with chronic kidney disease despite ICD therapy for the primary prevention of sudden death. Pacing Clin Electrophysiol Robin J Weinberg K Tiongson J et al. Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverterdefibrillator recipients. Heart Rhythm Herzog CA Li S Weinhandl ED et al. Survival of dialysis patients after cardiac arrest and the impact of implantable cardioverter defibrillators. Kidney Int 檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶檶 http / /www. njszb. com model systems gyc_626828@ hotmail. com http / /www. njszb. com