Defective kidneys that cannot filter impurities from the blood may increase the risk of sudden cardiac death in women, a new study led by an Indian origin researcher has found.
University of California-San Francisco researcher Rajat Deo, M.D. and colleagues, analyzed 2,760 postmenopausal women with a history of some heart disease to determine whether less serious, unrecognized deficiencies in kidney function also raised the risk of sudden cardiac death (SCD).
After controlling for several baseline risk factors - including heart failure, age, smoking, heart rate and level of high-density lipoproteins (HDL, "good" cholesterol) - researchers found the risk of SCD in women with advanced kidney dysfunction was 3.16 times higher than in women with normal kidney function.
Sudden cardiac death occurs when the heart abruptly and unexpectedly stops beating, leading to death within minutes of the first symptoms.
"Sudden cardiac death is an important public health problem, but it is poorly understood and understudied, especially in women," said Deo.
People with end-stage kidney disease, who require dialysis to survive, are at particularly high risk: about 22 percent of deaths in these patients are caused by SCD. Chronic kidney disease is also associated with SCD risk in people with advanced heart failure.
Deo and colleagues examined data on postmenopausal women who participated in the Heart and Estrogen/progestin Replacement Study (HERS).
The women, average age 67 with none over 79, had been diagnosed with coronary heart disease because of a previous heart attack, coronary artery bypass surgery, angioplasty or tests showing more than 50 percent narrowing in one or more coronary arteries. Some of the women had mild heart failure, but none had severe heart failure or end-stage renal disease.
At the start of HERS, researchers measured blood creatinine, a waste product that healthy kidneys remove from the blood. Creatinine levels were used to estimate the filtering ability of the kidneys (the glomerular filtration rate, or eGFR).
During the 6.8-year follow-up period, 135 of the women experienced SCD -36 of those had normal kidney function; 69 of those had moderate kidney dysfunction ; 30 of those had advanced kidney dysfunction.
Other women at heightened SCD risk during the HERS study were those who had a heart attack or were hospitalized one or more times for heart failure during the follow-up period. However, after controlling for these events, the risk remained 2.27 times as high for women with advanced kidney dysfunction.
"We found a strong, independent association between kidney function and SCD in a group of women with coronary heart disease who were not on dialysis and had less sick hearts than patients in previous studies," Deo said.
"We already know that patients with kidney disease are at greater risk of heart attack, heart failure and stroke. This study extends that concern to SCD and supports previous recommendations that people with kidney disease be monitored aggressively for cardiac risk factors," he added.
The study is published in Hypertension: Journal of the American Heart Association.