Sudden cardiac death in patients with chronic kidney disease: prevention is the sine qua non

Abstract

Despite developments in the technology of dialysis procedures and improvements in the understanding of systemic derangements related to chronic kidney disease (CKD), cardiovascular disease is the major cause of death. Unfortunately, the leading subset of cardiovascular disease death is sudden cardiac death (SCD). To date much effort has been exerted to figure out the clues pointing to the risk of future development of SCD in patients with CKD. However, none of these factors satisfactorily detects a truly vulnerable dialysis patient. Thus, recently, it has been advocated that a combination of noninvasive risk assessment methods, carefully chosen to reflect the different aspects of the underlying pathology and changes in the myocardial substrate in CKD, could help to identify patients at high risk of SCD within the CKD. In this review, we aimed to summarize what is known about risk stratification of patients with CKD and appropriate prevention strategies with a special emphasis on recent developments and the use of complimentary tests perhaps as a risk prediction rule.