20 5 2011 10 475 43% QT Sudden death in patients with hemodialysis LI Chuan GONG De-hua Research Institute of Nephrology Jingling Hospital Nanjing University School of Medicine Nanjing 210002 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 = 0. 37 < 1h 9% 35% 24h 26% 2 MHD end stage renal disease ESRD sudden cardiac death SCD heart failure HF MHD MHD 210002 left ventricular hypertrophy LVH 4 LVH MHD LVH HF
476 J Nephrol Dialy Transplant Vol. 20 No. 5 Oct. 2011 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 2 1. 06 1. 08 13
20 5 2011 10 477 QT Parekh 14 1 041 QT MHD Karnik 17 C CRP 6 IL-6 2 Bleyer 16 13% MHD < 3. 5 meq /L 1h QT MHD Santoro 18 MHD 1. 7 3 renalase MHD β β MHD 0 1. 0 meq /L USRDS MHD 2 93 /1 000 MHD 5 β β 164 /1 000 2002 MHD 5 286 /1 000 3 24% 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
478 J Nephrol Dialy Transplant Vol. 20 No. 5 Oct. 2011 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 < 0. 001 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 ~ 75 26 Pun CKD 5 75 ~ 80 21 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%
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