among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 2012; 7:765. 10. Wheeler DC, London GM, Parfrey PS, et al. Effects of cinacalcet on atherosclerotic and nonatherosclerotic cardiovascular events in patients receiving hemodialysis: the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial. J Am Heart Assoc 2014; 3:e001363. 11. US Renal Data System. USRDS 2011 Annual Data Report. National Institutes of Heatlh; Natio nal Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2011. 12. Rea TD, Pearce RM, Raghunathan TE, et al. Incidence of out-of-hospital cardiac arrest. Am J Cardiol 2004; 93:1455. 13. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int 1999; 55:1553. 14. Bleyer AJ, Hartman J, Brannon PC, et al. Characteristics of sudden death in hemodialysis patients. Kidney Int 2006; 69:2268. 15. Wong MC, Kalman JM, Pedagogos E, et al. Bradycardia and asystole is the predominant mechanism of sudden cardiac death in patients with chronic kidney disease. J Am Coll Cardiol 2015; 65:1263. 16. Wong MC, Kalman JM, Pedagogos E, et al. Temporal distribution of arrhythmic events in chronic kidney disease: Highest incidence in the long interdialytic period. Heart Rhythm https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 12/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate 2015; 12:2047. 17. Charytan DM, Koplan BA, Podoll AS, et al. Greater frequency of clinically significant bradycar dia than ventricular tachycardia in hemodialysis patients: Preliminary results of the monitori ng in dialysis (MiD) study. J Am Society of Nephrology 2014; 25 (Abstract). 18. Passman RS, Herzog CA. Bad things come to those who wait: Dialysis, sudden death, and the long interdialytic period. Heart Rhythm 2015; 12:2056. 19. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001; 345:1473. 20. Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997; 336:1629. 21. Shastri S, Tangri N, Tighiouart H, et al. Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study. Clin J Am Soc Nephrol 2012; 7:123. 22. Herzog CA, Strief J, Gilbertson DT. Cause-specific mortality of dialysis patients after coronary revascularization: Why don't dialysis patients have better survival after coronary intervention? [Abstract]. Circulation Suppl 2004; 110:493. 23. Herzog CA, Strief JW, Collins AJ, Gilbertson DT. Cause-specific mortality of dialysis patients after coronary revascularization: why don't dialysis patients have better survival after coronary intervention? Nephrol Dial Transplant 2008; 23:2629. 24. Pun PH, Lehrich RW, Honeycutt EF, et al. Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics. Kidney Int 2011; 79:218. 25. Karaboyas A, Zee J, Brunelli SM, et al. Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2017; 69:266. 26. Makar MS, Pun PH. Sudden Cardiac Death Among Hemodialysis Patients. Am J Kidney Dis 2017; 69:684. 27. FHN Trial Group, Chertow GM, Levin NW, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med 2010; 363:2287. 28. Young BA. Prevention of sudden cardiac arrest in dialysis patients: can we do more to improve outcomes? Kidney Int 2011; 79:147. 29. Mangrum JM, Lin D, Dimarco J, et al. Prognostic value of left ventricular systolic function in renal dialysis patients [Abstract]. Heart Rhythm 2006; 3:S154. 30. Zoccali C, Mallamaci F, Parlongo S, et al. Plasma norepinephrine predicts survival and incident cardiovascular events in patients with end-stage renal disease. Circulation 2002; 105:1354. https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 13/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate 31. Stenvinkel P. Inflammation in end-stage renal disease: the hidden enemy. Nephrology (Carlton) 2006; 11:36. 32. Bellomo G, Lippi G, Saronio P, et al. Inflammation, infection and cardiovascular events in chronic hemodialysis patients: a prospective study. J Nephrol 2003; 16:245. 33. Rodriguez-Benot A, Martin-Malo A, Alvarez-Lara MA, et al. Mild hyperphosphatemia and mortality in hemodialysis patients. Am J Kidney Dis 2005; 46:68. 34. Packer M, Lee WH. Provocation of hyper- and hypokalemic sudden death during treatment with and withdrawal of converting-enzyme inhibition in severe chronic congestive heart failure. Am J Cardiol 1986; 57:347. 35. Reiter MJ, Mann DE, Williams GR. Interaction of hypokalemia and ventricular dilatation in isolated rabbit hearts. Am J Physiol 1993; 265:H1544. 36. Halperin BD, Adler SW, Mann DE, Reiter MJ. Mechanical correlates of contraction-excitation feedback during acute ventricular dilatation. Cardiovasc Res 1993; 27:1084. 37. Chan KE, Lazarus JM, Hakim RM. Digoxin associates with mortality in ESRD. J Am Soc Nephrol 2010; 21:1550. 38. Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999; 10:1606. 39. Mangrum AJ, Lin D, Dimarco J. Sudden cardiac death and left ventricular function in hemodialysis patients [Abstract]. Heart Rhythm 2006; 2:S33. 40. Yamada S, Ishii H, Takahashi H, et al. Prognostic value of reduced left ventricular ejection fraction at start of hemodialysis therapy on cardiovascular and all-cause mortality in end- stage renal disease patients. Clin J Am Soc Nephrol 2010; 5:1793. 41. Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001; 12:2131. 42. Kruger A, Stewart J, Sahityani R, et al. Laser Doppler flowmetry detection of endothelial dysfunction in end-stage renal disease patients: correlation with cardiovascular risk. Kidney Int 2006; 70:157. 43. Levin A, Singer J, Thompson CR, et al. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996; 27:347. 44. Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974; 290:697. https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 14/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate 45. Mall G, Huther W, Schneider J, et al. Diffuse intermyocardiocytic fibrosis in uraemic patients. Nephrol Dial Transplant 1990; 5:39. 46. Schietinger BJ, Brammer GM, Wang H, et al. Patterns of late gadolinium enhancement in chronic hemodialysis patients. JACC Cardiovasc Imaging 2008; 1:450. 47. Friedman AN, Groh WJ, Das M. A pilot study in hemodialysis of an electrophysiological tool to measure sudden cardiac death risk. Clin Nephrol 2007; 68:159. 48. Wang AY, Lam CW, Chan IH, et al. Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis. Hypertension 2010; 56:210. 49. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45:S1. 50. Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002; 106:2941. Topic 1922 Version 29.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 15/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate GRAPHICS Trends in death rates in dialysis patients per 100 patient-years and annual perce change from 1996 to 2013 Adapted from: Peer Dialysis Initiative. Peer Report: Dialysis Care and Outcomes in the United States, 2016, Chronic Disease Research Group, Minneapolis, MN, 2016. Graphic 116349 Version 1.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 16/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate All-cause cardiovascular versus sudden cardiac death in dialysis patients per 100 patient-years in the United States SCD: sudden cardiac death. Adapted with permission from: Peer Kidney Care Initiative. Peer Report: Dialysis Care and Outcomes in the United States 2016. Chronic Disease Research Group, Minneapolis, MN, 2016. Copyright 2016 Chronic Disease Research Group. Graphic 116351 Version 1.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 17/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Cause-specific mortality in incident dialysis patients after first dialysis session in a freestanding facility https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 18/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate According to the Death Notification Form; 2011. https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 19/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Reproduced from: Weinhandl E, Constantini E, Everson S, et al. Peer kidney care initiative 2014 report: Dialysis care and outcomes in the United States. Am J Kidney Dis 2015; 65(6 Suppl 1): S1. Illustration used with the permission of Elsevier Inc. All rights reserved. Graphic 106384 Version 1.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 20/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Distribution of causes of death during the first year of dialysis According to the Death Notification Form; 2011. Reproduced from: Weinhandl E, Constantini E, Everson S, et al. Peer kidney care initiative 2014 report: Dialysis care and outcomes in the United States. Am J Kidney Dis 2015; 65(6 Suppl 1): S1. Illustration used with the permission of Elsevier Inc. All rights reserved. Graphic 106385 Version 1.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 21/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Figure showing risk of cardiac arrest among hemodialysis patients Incident Medicare dialysis patients age 20 years and older, 2000 to 2002 combined. Monthly event rates during the first six months and mean monthly event rates during each following six-month interval. Adjusted for age, gender, race, and diabetic status. Data from US Renal Data System. USRDS 2006 Annual Data Report. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2006. Graphic 81852 Version 3.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 22/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Adjusted mortality by treatment modality and number of months after treatment initiation among ESRD patients, 2014 Data source: Special analyses, USRDS ESRD database. Adjusted (age, race, sex, ethnicity, and primary diagnosis) mortality among 2013 incident ESRD patients during the first year https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 23/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate of therapy. Reference population: incident ESRD patients, 2011. ESRD: end-stage renal disease; USRDS: United States Renal Data System; PD: peritoneal dialysis; HD: hemodialysis. Reproduced from: United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017. Graphic 116354 Version 3.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 24/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Factors that contribute to sudden cardiac death (SCD) in dialysis patients Coronary artery disease/myocardial infarction Significant left ventricular hypertrophy Anemia/calcium/phosphorus/parathyroid hormone Uremia Chronic fluid overload Inflammation Electrolyte abnormalities Autonomic imbalance Heart failure/decreased left ventricular function Graphic 63859 Version 3.0 https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 25/26 7/6/23, 1:37 PM Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients - UpToDate Contributor Disclosures Charles A Herzog, MD Equity Ownership/Stock Options: Boston Scientific [Medical devices]; GE [Medical devices, echo contrast]; Johnson & Johnson [Pharmaceuticals, medical devices]; Merck [Pharmaceuticals]; Pfizer [Pharmaceuticals]. Grant/Research/Clinical Trial Support: Relypsa [Pharmaceuticals, hypo- and hyperkalemia]. Consultant/Advisory Boards: AstraZeneca [Pharmaceuticals, potassium binders]; Bayer [Diabetes, chronic kidney disease, heart failure/pharmaceuticals]; Diamedica [Diabetes, pharmaceuticals]; Fibrogen/DSMB [Pharmaceuticals, anemia]; Merck [Pharmaceuticals]; NxStage [Medical devices]; Relypsa /Vifor [Pharmaceuticals, hyperkalemia]. All of the relevant financial relationships listed have been mitigated. Rod Passman, MD, MSCE Grant/Research/Clinical Trial Support: Abbott [Ablation]; AHA [Ablation]; NIH [Stroke prevention]. Consultant/Advisory Boards: Abbott [Ablation]; iRhythm [Monitoring]; Janssen [Atrial fibrillation detection]; Medtronic [Implantable cardiac monitors]. Speaker's Bureau: iRhythm [Monitoring]. All of the relevant financial relationships listed have been mitigated. Jeffrey S Berns, MD No relevant financial relationship(s) with ineligible companies to disclose. Eric N Taylor, MD, MSc, FASN No relevant financial relationship(s) with ineligible companies to disclose. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/evaluation-of-sudden-cardiac-arrest-and-sudden-cardiac-death-in-dialysis-patients/print 26/26