Type of arrhythmias and the risk of sudden cardiac death in dialysis patients: a systematic review and meta-analysis

Subhash Chander; Ahmad Bin Aamir; Rabia Latif; Om Parkash; F N U Sorath; Sam Tan; Abhi Chand Lohana; Sheena Shiwlani; Mohammed Yaqub Nadeem

doi:10.1186/s43044-025-00606-6

Type of arrhythmias and the risk of sudden cardiac death in dialysis patients: a systematic review and meta-analysis

Egypt Heart J. 2025 Jan 13;77(1):11. doi: 10.1186/s43044-025-00606-6.

Authors

Subhash Chander¹, Ahmad Bin Aamir², Rabia Latif³, Om Parkash⁴, F N U Sorath⁵, Sam Tan⁶, Abhi Chand Lohana⁷, Sheena Shiwlani⁶, Mohammed Yaqub Nadeem⁷

Affiliations

¹ Department of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. subhash.lumhs@gmail.com.
² Department of Medicine, Faisalabad Medical University, Faisalabad, Pakistan.
³ Department of Physiology, College of Medicine, Imam Abdulrahman, Bin Faisal University, Dammam, Saudi Arabia.
⁴ Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
⁵ Department of Anesthesiology, Dow Health Science, Karachi, Pakistan.
⁶ Department of Medicine, Icahn School of Medicine, New York, NY, USA.
⁷ Department of Medicine, Western Michigan University, Kalamazoo, WV, USA.

PMID: 39804455
DOI: 10.1186/s43044-025-00606-6

Abstract

Background: Patients on long-term dialysis for end-stage kidney disease have a high mortality rate, predominantly due to sudden cardiac death (SCD), which is associated with an increased risk of arrhythmias compared to the general population. Thus, the current systematic review and meta-analysis aimed to investigate the incidence of SCD among dialysis patients at risk of arrhythmia.

Methods: This systematic review and meta-analysis followed the PRISMA guidelines. PubMed, Cochrane Library, Google Scholar, Medline, and Europe PMC were searched for articles meeting our inclusion criteria. Studies with risk assessment of arrhythmias and the incidence of SCD in dialysis patients were considered for inclusion. Effect size from eligible studies was pooled using a random effects model and restricted maximum likelihood estimation. Heterogeneity was quantified using the I² statistic, and the risk of publication bias was evaluated by visually inspecting funnel plots.

Results: Our search strategy yielded 5861 studies, of which 1960 duplicate entries were removed in the prescreening stage, 3326 were excluded after title/abstract screening, and 519 after full-text screening for not meeting our inclusion criteria. Finally, 11 studies were included in the analysis, and two more were selected from the bibliography list of previous reviews. Eight included studies were randomized controlled trials, and five were cohort studies, which provided a pooled population size of 12,611 dialysis patients for the meta-analysis, which indicated a significantly larger effect size of arrhythmia [Cohen's d = 110.38 (95%CI 42.72-178.05), p = 0.0]. Visual assessment of the funnel plot indicated no publication bias.

Conclusion: SCD remains a significant public health concern, particularly in patients undergoing dialysis. Meta-analysis results show that bradyarrhythmia is a common arrhythmic condition leading to SCD; however, other arrhythmias should also be considered.

Keywords: Arrhythmia; Bradyarrhythmia; ESRD; Hemodialysis; Sudden cardiac death.

Publication types

Review