Deo R et al. (2008) Kidney dysfunction and sudden cardiac death among women with coronary heart disease. Hypertension 51: 1578–1582

Approximately 22% of all deaths in patients with end-stage renal disease are caused by sudden cardiac death (SCD), but it is not known whether less-severe kidney function is also associated with SCD. Deo et al. have established that moderate to severely impaired kidney function is an independent predictor of SCD in postmenopausal women with coronary heart disease.

This was a subanalysis of data from the randomized, placebo-controlled Heart and Estrogen/Progestin Replacement Study, which investigated the effect of daily medroxyprogesterone acetate and conjugated estrogens on the risk of cardiovascular events in postmenopausal women with a history of coronary heart disease. Baseline serum creatinine levels were available for 2,760 participants, of whom 230 had an estimated glomerular filtration rate (eGFR; as determined by the Modification of Diet in Renal Disease equation) of <40 ml/min, 1,503 an eGFR of 40–60 ml/min, and 1,027 an eGFR of >60 ml/min.

During the follow-up period of 6.8 years, the rate of SCD was higher in women with moderate to advanced kidney dysfunction (eGFR <40 ml/min) than in those with less severely impaired renal function (eGFR 40–60 ml/min and >60 ml/min; 1.7%, 0.6% and 0.5% per year, respectively; P <0.001 for trend). There was no significant difference in the incidence of SCD between women with an eGFR of >60 ml/min and those with an eGFR of 40–60 ml/min. Adjustment for incident myocardial infarction and congestive heart failure—both of which were predictors of SCD—only slightly attenuated the association between kidney dysfunction and SCD (P <0.003).