Risk assessment for sudden cardiac death in dialysis patients: how relevant are conventional cardiac risk factors?

Patients with end stage renal disease on long term dialysis support have a very high risk of sudden cardiac death (SCD) presumably due to serious ventricular arrhythmias. Implantable cardioverter defibrillators (ICD) can be life saving in patients with SCD but their role in dialysis patients is unclear. Much of the current evidence on this important clinical issue limits to retrospective analysis of patients who received an ICD for conventional cardiac indication. It appears that there are certain factors that are unique to patients with renal failure which pre-disposes them to such high incidence of SCD and by applying the conventional risk assessment model on this sub-group of patients we are likely to miss a significant proportion of patients who would not fulfil that criteria but would be at high risk of SCD. In order to clarify this issue, we performed a retrospective screening of patients with end stage renal disease on haemodialysis using conventional risk assessment model and compared the outcome with the known incidence of SCD in this sub-group.