Sudden Cardiac Arrest Associated with Hemodialysis

Abstract

Key Points Around 25% of sudden cardiac arrest (SCA) cases among dialysis patients were associated with the dialysis procedure, a rate nearly three times higher than expected by chance. SCA events were more likely to occur on dialysis days, especially after long interdialytic periods, such as on Mondays and Tuesdays. A significant portion (23.4%) of SCA events associated with dialysis occurred within the first hour postdialysis, highlighting the need for careful monitoring. Background Individuals with ESKD may be at increased risk of sudden cardiac arrest (SCA) associated with dialysis therapy. However, community-based studies with comprehensive adjudication of SCA are lacking. Methods We conducted a community-based study using a case-case study design in a US population of approximately 1 million. All SCA cases with CKD were ascertained prospectively (2002–2020). We reviewed emergency medical services narratives and archived medical records from regional hospitals to capture patients' dialysis history, schedules, and the timing of SCA events in relation to dialysis sessions. Among those on regular hemodialysis, individuals who suffered SCA during hemodialysis or within an hour after completing hemodialysis (intradialytic/immediate posthemodialysis [IIHD]) were compared to cases with SCA at other times (non-IIHD). Noncompliant individuals or those intolerant of dialysis were excluded. Results Of 1023 SCA cases with CKD, 195 (19.1%) were undergoing regular scheduled hemodialysis. Among these cases, 24.1% were IIHD SCA, while 75.9% occurred non-IIHD. The incidence of SCA during dialysis was 2.9 times higher than expected by chance. SCA events were more likely to occur on dialysis days (65.3% of events) versus 34.7% events on the four off dialysis days ( P < 0.001). IIHD SCA had higher serum sodium (138.9±4.8 versus 135.5±5.5 mmol/L, P = 0.005), lower serum potassium (3.6±0.7 versus 5.6±1.6 mmol/L, P < 0.001), and higher bicarbonate levels (25.9±6.6 versus 20.2±5.5 mmol/L, P < 0.001) compared with their non-IIHD SCA counterparts. Regarding resuscitation details, IIHD SCA had a higher percentage of shockable rhythm (46.5% versus 32.4%, P = 0.09), witnessed collapse (85.1% versus 53.4%, P < 0.001), bystander cardiopulmonary resuscitation (72.3% versus 37.9%, P < 0.001), return of spontaneous circulation (66.0% versus 42.5%, P = 0.005), and survival to hospital discharge (30.4% versus 5.4%, P < 0.001) compared with non-IIHD SCA. Conclusions In patients undergoing dialysis, SCA events were significantly more common on dialysis days and three-fold higher than expected by chance. We identified potential risk factors and survival outcome differences between IIHD versus non-IIHD SCA groups that warrant future investigation.

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