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Sudden Cardiac Death in CKD and ESKD: Risk Factors, Mechanisms, and Therapeutic Strategies

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Cardio-Nephrology

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Abstract

Sudden cardiac death is a leading cause of death in end-stage kidney disease. Unlike in the general population, the predominant mechanism is thought not to be coronary atheroma but rather the uremic milieu and associated factors such as left ventricular hypertrophy, vascular calcification and electrolyte abnormalities. Likewise, whilst it is established that the arrhythmias that lead to SCD in the general population are most often ventricular tachyarrhythmias, there is little evidence that the same is true in end-stage kidney disease. Whilst there are mechanistic reasons why such patients may be prone to ventricular tachyarrhythmia, it is also thought that they suffer a proportionately higher rate of bradyarrhythmic, and indeed non-arrhythmic, sudden deaths than the general population. These factors mean that the therapeutic strategies which are proven to be effective to prevent sudden cardiac death in the general population, principally implanted cardioverter-defibrillator device implantation, may not be as effective in end-stage kidney disease. Instead, there is a need to develop a population-specific approach to management, and risk assessment. These strategies are discussed in this chapter.

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  1. Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    Darren Green, Diana Y. Y. Chiu & Philip A. Kalra

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  2. Diana Y. Y. Chiu
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  1. Department of Internal Medicine, Einstein Medical Center, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Janani Rangaswami

  2. Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, USA

    Edgar V. Lerma

  3. Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

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Green, D., Chiu, D.Y.Y., Kalra, P.A. (2017). Sudden Cardiac Death in CKD and ESKD: Risk Factors, Mechanisms, and Therapeutic Strategies. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_3

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