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Vol. 27, No. 1, 2007
Issue release date: March 2007
Am J Nephrol 2007;27:7–14

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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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.

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  1. Menon V, Sarnak MJ: The epidemiology of chronic kidney disease stages 1 to 4 and cardiovascular disease: a high-risk combination. Am J Kidney Dis 2005;45:223–232.
  2. Herzog CA: Cardiac arrest in dialysis patients. Semin Dial 2004;17:184–185.
  3. Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, Coresh J, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 2003;4:47–55.

    External Resources

  4. Ritz E, McClellan WM: Overview: increased cardiovascular risk in patients with minor renal dysfunction: an emerging issue with far-reaching consequences. J Am Soc Nephrol 2004;15:513–516.
  5. Pinkau T, Hilgers KF, Veelken R, Mann JF: How does minor renal dysfunction influence cardiovascular risk and the management of cardiovascular disease? J Am Soc Nephrol 2004;15:517–523.
  6. Shlipak MG, Fried LF, Stehman-Breen C, Siscovick D, Newman AB: Chronic renal insufficiency and cardiovascular events in the elderly: findings from the Cardiovascular Health Study. Am J Geriatr Cardiol 2004;13:81–90.
  7. Manjunath G, Tighiouart H, Coresh J, Macleod B, Salem DN, Griffith JL, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. Kidney Int 2003;63:1121–1129.
  8. Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD: Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int 2002;62:1402–1407.
  9. Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS: Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 2002;137:563–570.
  10. Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 2002;137:555–562.
  11. Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002;13:745–753.
  12. Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH: Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164:659–663.
  13. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108:2154–2169.
  14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560–2572.
  15. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(suppl 1):S1–S266.
  16. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial II Investigators: prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.
  17. Goldenberg I, Moss AJ, McNitt S, Zareba W, Andrews ML, Hall WJ, Greenberg H, Case RB; Multicenter Automatic Defibrillator Implantation Trial-II Investigators: Relations among renal function, risk of sudden cardiac death, and benefit of the implanted cardiac defibrillator in patients with ischemic left ventricular dysfunction. Am J Cardiol 2006;98:485–490.
  18. Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER, Andrews ML: Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II). J Am Coll Cardiol 2004;43:1459–1465.
  19. Smilde TD, van Veldhuisen DJ, Navis G, Voors AA, Hillege HL: Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction. Circulation 2006;114:1572–1580.
  20. O’Meara E, Chong KS, Gardner RS, Jardine AG, Neilly JB, McDonagh TA: The Modification of Diet in Renal Disease (MDRD) equations provide valid estimations of glomerular filtration rates in patients with advanced heart failure. Eur J Heart Fail 2006;8:63–67.
  21. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, Burgess E, Jindal K, Barrett B, Singer J, Djurdjev O: Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 1999;34:125–134.
  22. Tonelli M, Moye L, Sacks FM, Kiberd B, Curhan G; Cholesterol and Recurrent Events (CARE) Trial Investigators: Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Ann Intern Med 2003;138:98–104.
  23. Gruppo Emodialisie Patologie Cardiovasculari: Multicentre, cross-sectional study of ventricular arrhythmias in chronically haemodialysed patients. Lancet 1988;2:305–309.
  24. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, Sarnak MJ: Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2001;38:955–962.
  25. Khan NA, Ma I, Thompson CR, Humphries K, Salem DN, Sarnak MJ, Levin A: Kidney function and mortality among patients with left ventricular systolic dysfunction. J Am Soc Nephrol 2006;17:244–253.
  26. Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE: Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol 2000;11:912–916.
  27. Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray DC, Barre PE: Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transplant 1996;11:1277–1285.
  28. Paoletti E, Specchia C, Di Maio G, Bellino D, Damasio B, Cassottana P, Cannella G: The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant 2004;7:1829–1834.

    External Resources

  29. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC; American College of Cardiology/American Heart Association: ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2001;104:2996–3007.
  30. Trespalacios FC, Taylor AJ, Agodoa LY, Bakris GL, Abbott KC: Heart failure as a cause for hospitalization in chronic dialysis patients. Am J Kidney Dis 2003;41:1267–1277.
  31. Cice G, Ferrara L, D’Andrea A, D’Isa S, Di Benedetto A, Cittadini A, Russo PE, Golino P, Calabro R: Carvedilol increases two year survival in dialysis patients with dilated cardiomyopathy. J Am Coll Cardiol 2003;41:1438–1444.
  32. Kearney MT, Fox KA, Lee AJ, Brooksby WP, Shah AM, Flapan A, Prescott RJ, Andrews R, Batin PD, Eckberg DL, Gall N, Zaman AG, Lindsay HS, Nolan J: Predicting sudden death in patients with mild to moderate chronic heart failure. Heart 2004;90:1137–1143.
  33. Galinier M, Vialette JC, Fourcade J, Cabrol P, Dongay B, Massabuau P, Boveda S, Doazan JP, Fauvel JM, Bounhoure JP: QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J 1998;19:1054–1062.
  34. Kearney MT, Fox KA, Lee AJ, Prescott RJ, Shah AM, Batin PD, Baig W, Lindsay S, Callahan TS, Shell WE, Eckberg DL, Zaman AG, Williams S, Neilson JM, Nolan J: Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol 2002;40:1801–1808.
  35. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470.

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