Article Text

  1. P. H. Pun,
  2. R. W. Lehrich,
  3. S. R. Smith,
  4. J. P. Middleton
  1. Division of Nephrology, Department of Medicine, Duke University, Durham, NC


Background Sudden cardiac arrest (SCA) is the single most common cause of death in ESRD, and it is implicated in over 50% of all cardiac deaths in hemodialysis patients. The prognosis for survival following an in-hemodialysis clinic arrest is dismal, with one series reporting a 32% 30-day survival rate and a 15% 1-year survival rate. The purpose of this study was to identify factors that predict survival following an in-clinic arrest in the outpatient hemodialysis population.

Methods All patients who suffered in-center SCA in the Gambro Healthcare System in the US from 2002-2005 were identified. Baseline demographic and clinical characteristics at the time of the event were compared between patients who did and patients who did not survive for 6 months after the event. Univariate and multivariate models were constructed to identify predictors of survival.

Results 789 patients who suffered from in-clinic SCA were identified; 124 patients (16%) survived 30 days and 85 patients (11%) survived 180 days. Univariable predictors of survival included younger age (62.6 yrs vs 68.6 yrs, p = .0001), female gender (60% vs 53%, p = .02), longer dialysis vintage (4.7 vs 3.3 yrs, p < .0001), higher albumin (3.7 vs 3.5 mg/dL, p = .009), the absence of an indwelling dialysis catheter (18% vs 40%, p = .0007), and a dialysis prescription using a low calcium dialysate (24% vs 14%, p = .001). Younger age and the absence of a dialysis catheter were multivariate predictors of survival. Traditional factors associated with cardiovascular mortality, including cardiovascular comorbidities, diabetes, hemoglobin, dialysis adequacy, and other characteristics of the dialysis prescription, did not predict survival at 30 or 180 days.

Conclusions This study verifies the abysmal outcome of SCA in a large, nationally representative, and contemporary cohort of hemodialysis patients. This analysis also suggests novel risk associations of advanced age and use of catheter-based dialysis access with outcome. However, few traditional cardiovascular risk factors are associated with survival from SCA. Future studies should focus on prevention or modification of nontraditional risk factors to improve outcomes from SCA.

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