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Review
. 2015 Nov-Dec;28(6):624-35.
doi: 10.1111/sdi.12419. Epub 2015 Aug 9.

Calcium and Sudden Cardiac Death in End-Stage Renal Disease

Esther D Kim  1 , Rulan S Parekh  1   2   3
Affiliations
Review

Calcium and Sudden Cardiac Death in End-Stage Renal Disease

Esther D Kim et al. Semin Dial. 2015 Nov-Dec.

Abstract

Sudden cardiac death (SCD) accounts for a quarter of all deaths in end-stage renal disease (ESRD) patients. While causative mechanisms of SCD in this high risk population remain poorly defined, interaction of the vulnerable myocardium with dialysis-related arrhythmic triggers is thought to play a major role. Recent evidence suggests that dialysis-induced derangement of calcium concentrations contributes to the increased risk of all-cause and cardiovascular mortality, vascular calcification, and SCD. Current KDIGO guidelines recommend avoiding high dialysate calcium concentrations as a precaution against adverse outcomes of increased calcium burden and vascular calcification. Conversely, low calcium concentration is also implicated in the development of SCD via increased QT dispersion and prolonged QT interval. Consequently, the optimal dialysate calcium concentration in dialysis patients remains debated and further studies are needed to establish the best strategy for managing calcium in dialysis patients.

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