Chronic kidney disease (CKD) encompasses a spectrum of diseases that are identified by a glomerular filtration rate below 90 mL/min/1.73m2 or the presence of proteinuria, or both of these, persisting for over 3 months. In population-based studies, mortality in patients with CKD is consistently several-fold higher than that in patients without CKD, and the risk increases as the severity of renal function worsens. Mortality risk is, not surprisingly, highest among those with end-stage kidney disease. In developed countries, patients with CKD and end-stage kidney disease do not die of renal disease, but die primarily of non-renal causes, the relative proportions of which change across the spectrum of renal function. In the early stages of CKD, malignancy tends to be the predominant case of death; however, as renal function worsens, the proportion of deaths related to cardiovascular disease increases. Coronary artery disease contributes to most cardiac deaths in those with milder CKD. The proportions of cardiac and overall deaths from heart failure and sudden cardiac death increase progressively as renal function declines. Sudden cardiac death is a major cause of death among patients with end-stage kidney disease. Multiple factors including underlying coronary artery disease, left ventricular hypertrophy, valvular heart disease, arrhythmias, volume and electrolyte abnormalities, uraemia, and inflammation all likely contribute to the increased risk of cardiovascular death. Much work is needed to understand the pathophysiology and develop strategies to prevent cardiovascular deaths especially in the CKD population.
Serum Potassium Levels and Risk of Sudden Cardiac Death Among Patients With Chronic Kidney Disease and Significant Coronary Artery Disease
