Table 3.

Strategies for the prevention of sudden cardiac death and future research directions.

Risk Factor	Strategies to Prevent Sudden Cardiac Death	Gaps in Knowledge & Future Research Areas
Potassium (K) accumulation and removal	Frequent serum K assessment and dialysate K adjustment. Avoid dialysate K <2 meq/L. Oral K binding resins.	Optimal dialysate-to-serum-K gradient. Safety and effectiveness of dialysate K profiling.
Bicarbonate homeostasis	Avoidance of low dialysate bicarbonate. Do not account for other perceived sources of base/buffer (e.g., acetate). Avoid using the wrong concept of “total buffer”	Optimal dialysate bicarbonate concentration. Better education and understanding of the role of acetate in acid concentrate, which should not be added to bicarbonate in the dialysate
Calcium (Ca) homeostasis	Avoid low dialysate Ca <2.5 meq/L. Avoid high dialysate-to-serum Ca gradient. Use vitamin D analogs, Ca-based binders, calcimimetics to optimize serum Ca.	Optimal dialysate-to-serum-Ca gradient.
Magnesium (Mg) homeostasis	Avoid low dialysate Mg. Titrating dialysate Mg in Mg-losing states (i.e., GI losses/diarrhea, PPI use, malnutrition).	Optimal dialysate Mg concentration.
Fluid accumulation and removal	Reduce salt and fluid intake. Diuretics among pts with RKF. Longer HD time. More frequent HD sessions. Nocturnal HD. Smaller dialysate-to-Na-gradient. Avoid intradialytic hypotension.	Practical bedside tools/devices to ascertain estimated dry weight and volume status. Optimal UFR for specific patient populations. Role of dialysate cooling.

Abbreviations: K, potassium; Ca, calcium; Mg, magnesium; GI, gastrointestinal; PPI, proton pump inhibitor; RKF, residual kidney function; HD, hemodialysis; Na, sodium; UFR, ultrafiltration rate.