Advanced kidney dysfunction independently predicts sudden cardiac death among women with coronary heart disease (CHD).


Rajat Deo, MD, of Johns Hopkins Hospital in Baltimore, and colleagues analyzed data from The Heart and Estrogen Replacement Study, which examined the effects of hormone therapy on cardiovascular events in 2,763 postmenopausal women with CHD.

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At baseline, 1,027 women (37%) had an estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m2, 1,503 (54%) had an eGFR of 40-60 mL/min per 1.73 m2, and 230 (8%) had an eGFR below 40 mL/min per 1.73 m2.


During 6.8 years of follow-up, there were 136 adjudicated sudden cardiac deaths, the authors reported in Hypertension (online ahead of print). The rate of sudden cardiac death was higher among those with reduced kidney function. It was 0.5%, 0.6%, and 1.7% per year for women with an eGFR higher than 60, 40-60, and less than 40 mL/min per 1.73 m2, respectively.


After adjusting for baseline risk factors, only an eGFR below 40 mL/min per 1.73 m2 remained strongly associated with sudden cardiac death, in-creasing by threefold the risk of sudden cardiac death.


After adjusting for incident congestive heart failure (CHF) and MI during follow-up, an eGFR below 40 was associated with a 2.3 times increased risk of sudden cardiac death, suggesting that CHF and MI mediated only part of the association between renal dysfunction and sudden cardiac death.