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Open Access Highly Accessed Review

Prevention of sudden cardiac death in patients with chronic kidney disease

Beata Franczyk-Skóra1, Anna Gluba1, Maciej Banach2*, Dariusz Kozłowski3, Jolanta Małyszko4 and Jacek Rysz1

Author Affiliations

1 Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland

2 Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, 90-549, Poland

3 Department of Cardiology and Electrotherapy, Second Chair of Cardiology, Medical University of Gdansk, Gdansk, Poland

4 Department of Nephrology and Transplantology, Medical University, Bialystok, Poland

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BMC Nephrology 2012, 13:162  doi:10.1186/1471-2369-13-162

Published: 3 December 2012

Abstract

Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients’ prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient.

Keywords:
Arrhythmias; Chronic kidney disease; Renal failure; Sudden cardiac death