Skip to main content
. Author manuscript; available in PMC: 2018 May 1.
Published in final edited form as: Am J Kidney Dis. 2017 Feb 17;69(5):684–695. doi: 10.1053/j.ajkd.2016.12.006

Table 1.

Possible Strategies for SCD Prevention in HD Patients

General Strategy Specific Intervention
Manage cardiomyopathy
 Systolic Dysfunction Use carvedilol in patients with dilated cardiomyopathy
 Diastolic dysfunction/LVH Consider more frequent HD to reduce left ventricular mass; consider use of spironolactone, ACE inhibitors, or ARBs
Minimize arrhythmic triggers
 Potassium shifts Monitor pre-dialysis potassium frequently, especially after hospitalization and change dialysate bath accordingly; avoid low (< 2 mEq/L) potassium baths; consider potassium modeling and potassium binding agents to reduce interdialytic hyperkalemia
 Calcium shifts Avoid low (< 2.5 mEq/L) calcium baths, especially with concurrent use of QT interval prolonging medications
 Metabolic alkalosis Avoid high dialysate bicarbonate concentrations in alkalotic patients; account for all sources of base in dialysate, including acetate
 Rapid ultrafiltration Encourage patient adherence to salt and fluid restrictions; avoid sodium ramping and large dialysate/serum sodium gradients; extend dialysis time so that ultrafiltration rates do not exceed 10 ml/kg/hr
 Dialysis-induced myocardial ischemia Lower dialysate temperature to between 0.5°C and 2°C below patient temperature to reduce intradialytic hypotension
 Medications Avoid QT interval prolonging medications whenever possible and reconcile medication list regularly
Weigh risks and benefits of ICDs Consider ICDs for secondary prevention; increase communication between nephrologists and cardiologists to consider risks and benefits of primary prevention ICDs; consider leadless defibrillators to reduce vascular and infectious risks
Improve response to cardiac arrest Increase dialysis clinic staff awareness of cardiac arrest risk and readiness to provide basic life support; encourage awareness and CPR training among patients and families

Adapted from Pun103 with permission of Elsevier.

Abbreviations: HD, hemodialysis; LVH, left ventricular hypertrophy; ACE inhibitors, angiotensin converting enzyme inhibitors; ARBs, angiotensin receptor blockers; ICDs, implantable cardioverter defibrillators; CPR, cardiopulmonary resuscitation