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Clinical |
Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
Correspondence to: K.M. Chow, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Chow_Kai_Ming{at}alumni.cuhk.net
Background: Relatively little is known of the
epidemiology and predictors of sudden death in peritoneal dialysis (PD)
populations. We aimed to identify the risk factors of sudden death among PD
subjects. Methods: To explore clinical correlates of sudden death
in PD patients, we conducted a population-based case-control study using data
from a single dialysis unit. Cases (n = 24) were defined as all PD
patients that met the criteria for sudden death during January 2003 through
December 2006. We also selected 48 control subjects that were selected from
the prevalent PD patient name list compiled in alphabetical order. Data on the
hemoglobin, potassium, and calcium levels, residual renal function, dialysis
adequacy, cardiovascular risks, comorbid conditions, concurrent use of
aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and
erythropoietin, electrocardiographic and echocardiographic findings were
extracted from case notes and computer records. Confounders were controlled by
logistic regression. Results: Over a period of 4 years, 24 PD patients (mean
age 61.4 ± 9.5 years, median duration of dialysis 3.1 years)
experienced sudden death. Univariate analyses showed that patients that died
suddenly were more likely to be male and to have diabetes mellitus, a history
of smoking, and a lower small solute clearance as measured by Kt/V. Cases of
sudden death were also more likely to have received blood transfusion within
the previous 1 year. There were no significant differences between patients
and controls for residual renal function, serum potassium levels, control of
blood pressure and mineral metabolism, or hemoglobin levels. Multivariate
regression analysis confirmed independent association between recent blood
transfusion and increased odds of sudden death [adjusted odds ratio (OR) 5.18,
95% confidence interval (CI) 1.44 – 18.6]. Two other factors
significantly associated with risk of sudden death were male gender (adjusted
OR 4.16, 95% CI 1.14 – 15.2) and diabetes mellitus (adjusted OR 5.33,
95% CI 1.53 – 18.6). Conclusion: This study shows that recent blood
transfusion is associated with an increased likelihood of sudden death in PD
patients. The mechanisms that underlie this observation are unclear.
KEY WORDS: Sudden death; mortality; cardiovascular disease; hemoglobin; transfusion.
Received 17 March 2008; accepted 13 May 2008.
This article has been cited by other articles:
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  A. J. Bleyer CLUES AT THE SCENE OF THE CRIME: SUDDEN DEATH IN DIALYSIS PATIENTS Perit. Dial. Int., January 1, 2009; 29(1): 23 - 25. [Full Text] [PDF]
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