Truyen Thien Tan Tri Tai, Uy-Evanado Audrey, Chugh Harpriya, Reinier Kyndaron, Charytan David M, Salvucci Angelo, Jui Jonathan, Chugh Sumeet S
Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States.
Nephrology Division, NYU Grossman School of Medicine, New York, NY, United States.
medRxiv. 2025 Mar 13:2025.03.12.25323871. doi: 10.1101/2025.03.12.25323871.
Moderate kidney dysfunction is independently associated with increased cardiovascular mortality. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) mortality.
We conducted a case-control study within an ongoing, prospective, community-based investigation of out-of-hospital SCA in the Portland, Oregon, metropolitan area (population ~ 1 million) from February 1st, 2002, to December 31st, 2020. Analysis included individuals aged 40 to 75 who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured prior to SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate (eGFR) of 30 to <60 mL/min/1.73 m (2021 CKD-EPI formula). A population-based SCA study in Southern California was used for validation.
We compared 2,068 SCA cases and 852 controls (mean ages: 61.4±8.5 and 62.7±8.0 years; males: 69.9% and 67.4%). SCA cases had more moderate CKD (17.7% vs. 14.7%, p<0.001) and lower eGFR (74.7 vs. 80.9 mL/min/1.73 m, p<0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (OR: 1.33, 95% CI: 1.03-1.72). Each 10 mL/min/1.73 m eGFR drop below 90 increased SCA risk (OR: 1.24, 95% CI: 1.18-1.31). Similar findings were observed in the validation cohort (817 SCA and 3,249 controls), where moderate CKD was associated with SCA (OR: 1.51, 95% CI: 1.16-1.97).
Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.
中度肾功能不全与心血管死亡率增加独立相关。心脏骤停（SCA）至少占慢性肾脏病（CKD）死亡率的25%。
我们在俄勒冈州波特兰市大都市区（人口约100万）于2002年2月1日至2020年12月31日正在进行的一项基于社区的院外心脏骤停前瞻性调查中开展了一项病例对照研究。分析纳入了40至75岁经历过心脏骤停的个体（病例组）和无心脏骤停病史的个体（对照组），在心脏骤停/入组前测量了肌酐水平。中度CKD定义为估算肾小球滤过率（eGFR）为30至<60 mL/min/1.73 m²（2021年CKD-EPI公式）。南加州一项基于人群的心脏骤停研究用于验证。
我们比较了2068例心脏骤停病例和852例对照（平均年龄：61.4±8.5岁和62.7±8.0岁；男性：69.9%和67.4%）。与对照组相比，心脏骤停病例有更多的中度CKD（17.7%对14.7%，p<0.001）和更低的eGFR（74.7对80.9 mL/min/1.73 m²，p<0.001）。多变量回归表明，中度CKD是心脏骤停的独立危险因素（OR：1.33，95%CI：1.03-1.72）。eGFR每低于90 mL/min/1.73 m²下降10 mL/min/1.73 m²，心脏骤停风险增加（OR：1.24，95%CI：1.18-1.31）。在验证队列（817例心脏骤停和3249例对照）中观察到类似结果，其中中度CKD与心脏骤停相关（OR：1.51，95%CI：1.16-1.97）。
中度CKD与普通人群心脏骤停风险增加相关。有必要进一步研究将中度肾功能不全潜在纳入心脏骤停风险分层。
