How can we reduce sudden cardiac death in cardiorenal syndrome?

While sudden cardiac death rates are inordinately high in advanced chronic kidney disease, evidencebased prevention algorithms are lacking. This article examines the difficulties of case definition in observational studies of intrinsically unhealthy populations, associations between event rates and declining kidney function, potentially modifiable risk markers, and the lack of evidence-based therapies. On the basis of high event rates, trials in the general population, and temporal patterns of event rates in dialysis patients, we argue that definitive trials of implanted cardioverter defibrillators, β-blockers, and more frequent hemodialysis need urgent consideration.