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 USA.
Nephrology Division, NYU Grossman School of Medicine New York NY USA.
J Am Heart Assoc. 2025 Aug 5;14(15):e042307. doi: 10.1161/JAHA.125.042307. Epub 2025 Jul 29.
Moderate kidney dysfunction is independently associated with increased cardiovascular death. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) death. This study aimed to evaluate the impact of moderate CKD on SCA risk.
We conducted a case-control study within a community-based investigation of SCA in the Portland, Oregon, metropolitan area from February 1, 2002, to December 31, 2020. Analysis included individuals aged 40 to 75 years who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured before SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate of 30 to <60 mL/min per 1.73 m (2021 Chronic Kidney Disease Epidemiology Collaboration formula). A population-based SCA study in southern California was used for validation.
We compared 2068 SCA cases and 852 controls (mean ages, 61.4±8.5 and 62.7±8.0 years, respectively; men: 69.9% and 67.4%, respectively). SCA cases had more moderate CKD (17.7% versus 14.7%, <0.001) and lower estimated glomerular filtration rate (74.7 versus 80.9 mL/min per 1.73 m, <0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (odds ratio, 1.32 [95% CI, 1.02-1.71]). Each 10 mL/min per 1.73 m estimated glomerular filtration rate drop to <90 increased SCA risk (odds ratio, 1.24 [95% CI, 1.18-1.31]). Similar findings were observed in the validation cohort (817 SCA and 3249 controls), where moderate CKD was associated with SCA (odds ratio, 1.54 [95% CI, 1.18-2.00]).
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风险增加独立相关。心脏骤停（SCA）至少占慢性肾脏病（CKD）死亡的25%。本研究旨在评估中度CKD对SCA风险的影响。
我们在2002年2月1日至2020年12月31日对俄勒冈州波特兰市大都市区进行的一项基于社区的SCA调查中开展了一项病例对照研究。分析纳入了年龄在40至75岁之间经历过SCA的个体（病例组）和无SCA病史的个体（对照组），并在SCA发生前/入组时测量了肌酐水平。中度CKD定义为估算肾小球滤过率为30至<60 mL/（min·1.73 m²）（采用2021年慢性肾脏病流行病学协作公式）。一项在南加州开展的基于人群的SCA研究用于验证。
我们比较了2068例SCA病例和852例对照（平均年龄分别为61.4±8.5岁和62.7±8.0岁；男性分别占69.9%和67.4%）。与对照组相比，SCA病例中有更多的中度CKD（分别为17.7%和14.7%，P<0.001）且估算肾小球滤过率更低（分别为74.7和80.9 mL/（min·1.73 m²），P<0.001）。多变量回归显示，中度CKD是SCA的独立危险因素（比值比，1.32 [95%CI，1.02 - 1.71]）。估算肾小球滤过率每下降10 mL/（min·1.73 m²）至<90 mL/（min·1.73 m²），SCA风险增加（比值比，1.24 [95%CI，1.18 - 1.31]）。在验证队列（817例SCA和3249例对照）中观察到了类似结果，其中中度CKD与SCA相关（比值比，1.54 [95%CI，1.18 - 2.00]）。
中度CKD与普通人群中SCA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SCA风险分层的可能性。
