Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics

Patrick H. Pun, Ruediger W. Lehrich, Emily F. Honeycutt, Charles A Herzog, John P. Middleton

Research output: Contribution to journalArticlepeer-review

222 Scopus citations


Sudden cardiac arrest is the most common cause of death among patients with end-stage kidney disease (ESKD) maintained on hemodialysis. Here we sought to identify dialysis-related factors associated with this increased risk in a case-control study encompassing 43,200 patients dialyzed in outpatient clinics of a large organization. Within this group, we compared the clinical and dialysis-specific data of 502 patients who experienced a sudden cardiac arrest with 1632 age- and dialysis-vintage-matched controls. There were 4.5 sudden cardiac arrest events per 100,000 dialysis treatments during the 3-year study period. These patients were significantly more likely to have been exposed to low potassium dialysate of less than 2 meq/l. These differences could not be explained by predialysis serum potassium levels. There was no evidence for a beneficial effect of low potassium dialysate even among those with higher predialysis serum potassium levels. Other factors strongly associated with sudden cardiac arrest by multivariable analysis included increased ultrafiltration volumes, exposure to low calcium dialysate, and predialysis serum creatinine levels. These relationships persisted after adjustment for covariates, but traditional risk factors such as history of coronary heart disease and congestive heart failure were not significantly influential. Hence, our study suggests that modifications of the hemodialysis prescription may improve the risk of sudden cardiac arrest in patients with ESKD.

Original languageEnglish (US)
Pages (from-to)218-227
Number of pages10
JournalKidney international
Issue number2
StatePublished - Jan 2011

Bibliographical note

Funding Information:
We thank DaVita Clinical Research (DCR) for providing the clinical data for this research project. These data were originally presented as a poster at the American Society of Nephrology Annual Meeting in November 2009. This work was supported in part by a National Institutes of Health Grant 1KL2-RR-024127-01 to PHP and by grant funding from Satellite Health Care.


  • cardiac
  • cardiovascular events
  • dialysis
  • end-stage kidney disease
  • risk factors


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