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Vol. 27, No. 1, 2007
Issue release date: March 2007
Section title: Original Report: Patient-Oriented, Translational Research
Am J Nephrol 2007;27:7–14
(DOI:10.1159/000098431)

Risk Factors for Sudden Cardiac Death in Patients with Chronic Renal Insufficiency and Left Ventricular Dysfunction

Chonchol M. · Goldenberg I. · Moss A.J. · McNitt S. · Cheung A.K.
aUniversity of Colorado Health Sciences Center, Denver, Colo., bUniversity of Rochester Medical Center, Rochester, N.Y., and cVeterans Affairs Salt Lake City Healthcare System and University of Utah, Salt Lake City, Utah, USA

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Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: 10/23/2006
Accepted: 11/30/2006
Published online: 1/5/2007

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: http://www.karger.com/AJN

Abstract

Background: Patients with ischemic left ventricular dysfunction have a high risk of sudden cardiac death (SCD). It is, however, unclear if the risk and risk factors of SCD in these patients is modulated by the coexistence of mild chronic renal insufficiency. Methods: We performed a post-hoc analysis of the outcome associated with mild renal dysfunction, as defined by an estimated glomerular filtration rate (eGFR) of <75 ml/min/1.73 m2 in patients allocated to the conventional medical therapy arm of the Multicenter Automatic Defibrillator Implantation Trial-II. Results: In multivariable analysis, renal dysfunction was independently associated with significant increased risks for all-cause mortality (hazard ratio [HR] = 1.86; 95% CI 1.13–3.05) and SCD (HR = 2.00; 95% CI 1.01–4.02), but not non-SCD, compared to patients without renal dysfunction. Independent predictors of SCD in patients with renal dysfunction were: increased resting heart rate (HR = 2.40; 95% CI 1.50–3.86); low diastolic blood pressure (HR = 3.23; 95% CI 1.52–6.66), and a prolonged QRS duration (HR = 1.63; 95% CI 1.02–2.61). β-Blocker therapy was independently associated with a significant reduction in the risk of SCD in patients with an eGFR of <75 ml/min/1.73 m2 (HR = 0.61; 95% CI 0.38–0.99). Conclusion: These findings suggest that renal dysfunction significantly increases the risk for SCD in patients with left ventricular dysfunction, and that β-blocker therapy reduces the risk of arrhythmic mortality in heart failure patients with coexisting renal insufficiency.


  

Author Contacts

Michel Chonchol, MD
Division of Renal Diseases and Hypertension
University of Colorado Health Sciences Center
Denver, CO 80262 (USA)
Tel. +1 303 399 6997, Fax +1 303 399 3131, E-Mail Michel.Chonchol@uchsc.edu

  

Article Information

Received: October 23, 2006
Accepted: November 30, 2006
Published online: January 5, 2007
Number of Print Pages : 8
Number of Figures : 1, Number of Tables : 4, Number of References : 35

  

Publication Details

American Journal of Nephrology

Vol. 27, No. 1, Year 2007 (Cover Date: March 2007)

Journal Editor: Bakris, G. (Chicago, Ill.)
ISSN: 0250–8095 (print), 1421–9670 (Online)

For additional information: http://www.karger.com/AJN


Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: 10/23/2006
Accepted: 11/30/2006
Published online: 1/5/2007

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: http://www.karger.com/AJN


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