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Abstract: FR-PO797

Factors Affecting Sudden Death in Hemodialysis Patients: Ten-Years Outcome of the Q-Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hiyamuta, Hiroto, Kyushu University, Fukuoka, Japan
  • Tanaka, Shigeru, Fukuoka Dental College, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Sawara-ku, FUKUOKA, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Fukuoka, Japan
Background

Sudden death is a serious problem in hemodialysis patients. However, the precise incidence rate of sudden death and its risk factors remain unclear.

Methods

A total of 3,506 Japanese HD patients aged ≥18 years were prospectively followed for 10 years. Sudden death was defined as sudden and unexpected natural death within 24 hours. Multivariate-adjusted hazard ratios (HR) with 95% confidence intervals (95% CI) of each risk factor of sudden death were calculated using a Cox proportional hazards model.

Results

During a follow-up period, 1,748 patients died from any causes and 227 of them (13%) were attributed to sudden death. In multivariable-adjusted Cox analysis, male sex (hazard ratio [HR] 1.65; 95% CI 1.19–2.30), age (HR 1.44; 95% CI 1.26–1.65 for every 10-years increase), presence of diabetes (HR 2.45; 95% CI 1.82–3.29), history of cardiovascular events (HR 1.85; 95% CI 1.38–2.46), cardiothoracic ratio in chest X-ray (HR 1.21; 95% CI 1.07–1.39 for every 5-percentage-point increase), serum levels of phosphate (HR 1.15; 95% CI 1.03–1.30 for every 1-mg/dL increase), and C-reactive protein (HR 1.11; 95% CI 1.03–1.20 for every 1-mg/dL increase) were independent predictors for developing sudden death. In subgroup analysis, shorter dialysis session length (<5 hours) was associated with an increased risk of sudden death in male group (HR 1.51; 95% CI 1.03– 2.21; p for interaction 0.01) or elderly group (≥ 65 years) (HR 2.45; 95% CI 1.82–3.29), and lower serum calcium level was a significant predictor for sudden death in female group (HR 1.88; 95% CI 1.36–2.63 for every 1mg/dL decrease; p for interaction <0.001).

Conclusion

The present study demonstrated the lower occurrence rate of sudden death compared to previous reports, but elucidated its specific risk factors, related to atherosclerosis, vascular calcification, left ventricular hypertrophy, and chronic inflammation, in hemodialysis patients.