1. ¹Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
2. ²Metrolina Nephrology Associates, Charlotte, North Carolina, USA
3. ³Duke Clinical Research Institute, Durham, North Carolina, USA

Correspondence: Patrick H. Pun, Division of Nephrology, Department of Medicine, Duke University Medical Center, BOX 3014 DUMC, Durham, North Carolina 27710, USA. E-mail: patrick.pun@duke.edu

⁴These authors contributed equally to study design, study conduct, and paper preparation.

Received 11 November 2008; Revised 24 April 2009; Accepted 5 May 2009; Published online 17 June 2009.

Abstract

Sudden cardiac death is the most common cause of mortality among patients with end-stage kidney disease maintained on hemodialysis. To examine whether this increased risk is also seen with less advanced kidney disease, we studied the relationship between glomerular filtration rate and risk of sudden cardiac death in patients with moderate kidney disease and known coronary artery disease. This retrospective longitudinal study encompassed 19,440 consecutive patients who underwent cardiac catheterization at a single academic institution. There were 522 adjudicated sudden cardiac death events, yielding an overall rate of 4.6 events per 1000 patient years. This figure reflected rates of 3.8 events in 14,652 patients with estimated glomerular filtration rates (eGFR) 60 (stage 2 CKD or better) and 7.9 events in 4788 patients with glomerular filtration rates <60 (stage 3–5 CKD), all normalized to 1000 patient-years. After adjusting for differences in known cardiac risk factors and other covariates in a multivariate Cox proportional hazards model, the eGFR was independently associated with sudden cardiac death (hazard ratio (HR)=1.11 per 10 ml/min decline in the eGFR). Our analysis found that reductions in the eGFR in CKD stages 3–5 are associated with a progressive increase in risk of sudden cardiac death in patients with coronary artery disease. Additional studies are needed to better characterize the mechanisms by which reduced kidney function increases this risk.