The Challenge of Sudden Death in Dialysis Patients

Abstract

Before his morbid event, the patient had been doing well on dialysis. He had less than 6 episodes of hypotension (<100 mmHg) per month. His average predialytic weight gain was 4 kg, and, with fluctuations, his average predialysis BP was 155/65 mmHg. While continuing on gliquidone (an oral sulfonylurea hypoglycemic drug that does not accumulate in renal failure), he had no episodes of hypoglycemia, and his last glycosylated hemoglobin level was 7.2%. His medical history is of hypertension, type 2 diabetes, and left ventricular hypertrophy (LVH) with an ejection fraction of 55%. His electrocardiogram showed signs of LVH and flat T waves. He had no history of hypoglycemic episodes and no evidence of retinopathy. He reported no episodes of arrhythmia or precordial pain. A predialysis chest x-ray 2 wk before the terminal event had shown pulmonary congestion. His medications included 0.25 μg/d calcitriol, calcium carbonate, 10 mg of folate, 80 mg of verapamil, and no β blockers. In addition, he received varying doses of darbepoietin and iron gluconate as required. He did not receive a statin.