Moderate Kidney Dysfunction Independently Increases Sudden Cardiac Arrest Risk: A Community-Based Study

Background

Moderate kidney dysfunction is independently associated with increased cardiovascular mortality. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) mortality.

Methods

We conducted a case-control study within an ongoing, prospective, community-based investigation of out-of-hospital SCA in the Portland, Oregon, metropolitan area (population ∼ 1 million) from February 1st, 2002, to December 31st, 2020. Analysis included individuals aged 40 to 75 who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured prior to SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate (eGFR) of 30 to <60 mL/min/1.73 m ² (2021 CKD-EPI formula). A population-based SCA study in Southern California was used for validation.

Results

We compared 2,068 SCA cases and 852 controls (mean ages: 61.4±8.5 and 62.7±8.0 years; males: 69.9% and 67.4%). SCA cases had more moderate CKD (17.7% vs. 14.7%, p<0.001) and lower eGFR (74.7 vs. 80.9 mL/min/1.73 m ² , p<0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (OR: 1.33, 95% CI: 1.03-1.72). Each 10 mL/min/1.73 m ² eGFR drop below 90 increased SCA risk (OR: 1.24, 95% CI: 1.18–1.31). Similar findings were observed in the validation cohort (817 SCA and 3,249 controls), where moderate CKD was associated with SCA (OR: 1.51, 95% CI: 1.16–1.97).

Conclusion

Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.

Clinical Perspective

• Our findings indicate that even moderate renal dysfunction was independently associated with sudden cardiac arrest (SCA) in two geographically distinct populations. A decline in eGFR below 90 mL/min/1.73m ² exhibited a dose-response relationship with SCA.

• Among SCA cases, moderate CKD was linked to a higher likelihood of presenting with a non-shockable rhythm at the time of the even, and lower survival rates to hospital discharge compared to those with normal or mild CKD.

• The findings have implications for the potential integration of moderate renal dysfunction and specifically eGFR, given its dose-response relationship, into SCA clinical risk stratification.