Cardiac arrest and sudden death in dialysis units

Background. For patients with end-stage renal disease and their providers. dialysis unit-based cardiac arrest is the most feared complication of hemod ialysis. However, relatively little is known regarding its frequency or epi demiology, or whether a fraction of these events could be prevented. Methods. To explore clinical correlates of dialysis unit-based cardiac arre st. 400 reported arrests over a nine-month period from October 1998 through June 1999 were reviewed in detail. Clinical characteristics of patients wh o suffered cardiac arrest were compared with a nationally representative co hort of > 77.000 hemodialysis patients dialyzed at Fresenius Medical Care N orth America-affiliated facilities. Results. The cardiac arrest rate was 400 out of 5,744.708. corresponding to a rate of 7 per 100,000 hemodialysis sessions. Cardiac arrest was more fre quent during Monday dialysis sessions than on other days of the week. Case patients were nearly twice as likely to have been dialyzed against a 0 or 1 .0 mEq/L potassium dialysate on the day of cardiac arrest (17.1 vs. 8.8%). Patients who suffered a cardiac arrest were on average older (66.3 +/- 12.9 vs. 60.2 +/- 15.4 years), more likely to have diabetes (61.8 vs. 36.8%), a nd more likely to use a catheter for vascular access (34.1 vs. 27.8%) than the general hemodialysis population. Sixteen percent of patients experience d a drop in systolic pressure of 30 mm Hg or more prior to the arrest. Thir ty seven percent of patients who suffered cardiac arrest had been hospitali zed within the past 30 days. Sixty percent of patients died within 48 hours of the arrest, including 13% while in the dialysis unit. Conclusions. Cardiac arrest is a relatively infrequent but devastating comp lication of hemodialysis. To reduce the risk of adverse cardiac events on h emodialysis, the dialysate prescription should be evaluated and modified on an ongoing basis. especially following hospitalization in high-risk patien ts.