Hemodialysis patients are at increased risk for sudden cardiac death.

Criteria: unexpected cardiac death within an hour of symptom onset, or death in a person apparently well in the past 24 hours with no noncardiac explanation


Mechanism of death: usually ascribed to a cardiac arrhythmia


Risk factors for sudden cardiac death:

(1) cardiomyopathy, with systolic and/or diastolic dysfunction

(2) rapid shifts in potassium concentrations as a result of dialysis

(3) rapid shifts in calcium concentrations as a result of dialysis

(4) metabolic alkalosis associated with a high dialysate bicarbonate concentration

(5) rapid ultrafiltration

(6) drugs causing QTc interval prolongation

(7) intradialytic hypotension with cardiac ischemia

(8) long interval between dialysis treatments with volume overload and hyperkalemia

(9) silent asymptomatic atrial fibrillation


Differential diagnosis:

(1) sepsis

(2) drug accumulation

(3) stroke

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