Types of Arrhythmias and the risk of sudden cardiac death in dialysis patients: A Systematic Review and Meta-analysis
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Abstract
Background
Patients on long-term dialysis therapy due to ESRD tend to have a high mortality rate, predominantly due to cardiovascular complications, which is associated with an increased risk of arrhythmias compared to the general population. Arrhythmia has been firmly identified as the primary cause of sudden death during dialysis, as studies have shown a correlation between the timing of dialysis sessions and episodes of sudden death, as well as relationships with serum or dialysate electrotype concentrations. It also associated with a six-fold increased risk of developing ventricular fibrillation following a first myocardial infarction.
Methods
This systematic review and meta-analysis followed the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The reviewers searched the Cochrane Library, MEDLINE, Europe PMC, and Google Scholar Databases for relevant data sources. We included only randomized controlled trials and cohort studies published in English. A quantitative analysis (meta-analysis) was conducted using Review Manager version 5.4 (RevMan 5.4; The Nordic Cochrane Center, The Cochrane Collaboration, 2014).
Results
The initial database search yielded 547 studies, of which 213 duplicates were excluded. The title, abstract, and full-text screening excluded 247 studies, and the final total included 13 studies reporting the incidence of SCD mortality in this meta-analysis.
Conclusion
SCD remains a major public health concern, particularly in patients undergoing dialysis. Meta-analysis results show that bradyarrhythmia emerges as a common type of arrhythmia leading to SCD; however, other types of arrhythmias should also be considered.
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Peer review report
Title: Types of Arrhythmias and the risk of sudden cardiac death in dialysis patients: A Systematic Review and Meta-analysis
version: 1
Referee: Milaras Nikias
Institution: National and Kapodistrian University of Athens- Ippokrateion Hospital
email: nikiasmil@med.uoa.gr
ORCID iD: 0000-0001-7312-0976
General assessment
It is now well known that high cardiovascular mortality in ESRD patients is only partly due to atherothrombotic events. Ventricular tachyarrhythmias and electromechanical dissociation account for a significant amount of those deaths as was reported in landmark trials such as the MADIT II. VT or VF might be the mode of death in only a minority of those patients and this is extrapolated from the fact that ICD implantation in this population does not extend survival, whether due to high competing …
Peer review report
Title: Types of Arrhythmias and the risk of sudden cardiac death in dialysis patients: A Systematic Review and Meta-analysis
version: 1
Referee: Milaras Nikias
Institution: National and Kapodistrian University of Athens- Ippokrateion Hospital
email: nikiasmil@med.uoa.gr
ORCID iD: 0000-0001-7312-0976
General assessment
It is now well known that high cardiovascular mortality in ESRD patients is only partly due to atherothrombotic events. Ventricular tachyarrhythmias and electromechanical dissociation account for a significant amount of those deaths as was reported in landmark trials such as the MADIT II. VT or VF might be the mode of death in only a minority of those patients and this is extrapolated from the fact that ICD implantation in this population does not extend survival, whether due to high competing comorbidities or due to electromechanical dissociation being the cause of death. It is true that ESRD patients are underrepresented in such studies due to the high competing factor for non-cardiac death and no safe conclusion can yet be drawn. It remains yet to be seen whether a better risk stratification algorithm through Holter monitoring or programmed ventricular stimulation can unveil those truly at high risk for SCD.
This meta-analysis tries to unveil the mode of death and the high cardiovascular mortality in renal failure through a thorough literature search that included 11 studies. This systematic review/meta-analysis follows current writing and reporting guidelines.
The English used is adequate although some parts of the manuscript could be refined (eg 3rd paragraph in Introduction)
Essential revisions that are required to verify the manuscript
ESRD and ESKD are both discussed in the manuscript. I would personally prefer that the authors devoted more effort in commenting on the meta-analysis results and its implications. The included studies are not adequately annotated in the text, making reading difficult for the statistically unschooled reader who must understand the plots provided.
Decision
Verified with reservations: The content is academically sound but has shortcomings that must be improved.
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