Abstract 14228: Chronic Kidney Disease, eGFR, and Risk of Sudden Cardiac Death: The Atherosclerosis Risks in Communities Study
Background: End stage renal disease is associated with higher risk of sudden cardiac death (SCD); however, little is known about association between early stages of chronic kidney disease (CKD) and SCD.
Methods/Results: We followed 13,427 middle aged (45-65 years old) men and women from four US communities free of CHD or heart failure at baseline from 1987-89 to 2001. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi equation (eGFRCr) at baseline. A physician panel adjudicated SCD, defined as death from a sudden, pulseless condition presumed to be due to a ventricular tachyarrhythmia. We explored the following relationship: a). eGFRCr with SCD using restricted cubic splines (with knots at eGFRCr of 60, 90, and 120) after truncating those with eGFR ≥140 or <30 and, b).CKD staging with SCD.
During follow up, a total of 190 (1.4%) cohort members had SCD. The rates of SCD increased exponentially (linear increase in log hazard) at eGFRCr below ~ 75 mL/min/1.73 m2 (Figure 1).
CKD stage 3+ (eGFRCr <60 mL/min/1.73 m2 ) was associated with 9.9 fold (95% CI 3.1 - 31.4) higher risk of SCD than eGFRCr ≥ 90 mL/min/1.73 m2 after adjustment for age, gender and race (Figure 2).
Adjustment for additional covariates including diabetes, hypertension, smoking status, LDL and HDL cholesterol, and BMI attenuated the above hazard ratio to 5.3 (95% CI: 1.6 - 16.9).
Conclusion: Even moderate reduction in kidney function is strongly associated with higher risk of sudden cardiac death in this middle aged cohort. Mechanisms may include a combination of vulnerable myocardium and a higher occurrence of arrhythmogenic triggers. Strategies for risk reduction should be explored.
- © 2013 by American Heart Association, Inc.