Electrocardiographic predictors of mortality and sudden cardiac death in patients with end stage renal disease on hemodialysis

Jonathan W. Waks, Larisa G. Tereshchenko, Rulan S. Parekh

    Research output: Contribution to journalArticlepeer-review

    22 Scopus citations


    Patients with end stage renal disease (ESRD) on hemodialysis experience a high incidence of cardiovascular mortality, and sudden cardiac death (SCD) accounts for approximately 25% of all deaths in this patient population. Despite this high risk of SCD, many non-invasive SCD risk stratification tools that are frequently applied to other patient populations (such as those with prior myocardial infarction and reduced left ventricular systolic function) may be less useful markers of increased SCD risk in ESRD. Improved SCD risk stratification tools for use specifically in patients on hemodialysis are therefore necessary to optimally target use of primary prevention interventions aimed at decreasing SCD incidence. Electrocardiography is an effective, non-invasive SCD risk stratification tool in hemodialysis patients. This article reviews data supporting the association between various ECG parameters (QT interval, spatial QRS-T angle, signal averaged ECG, heart rate variability, and T-wave alternans) and mortality/SCD in the dialysis population. Despite the association between abnormal ECG parameters and SCD, it remains unclear if these abnormal parameters (such as prolonged QT interval) are mechanistically related to SCD and/or ventricular arrhythmias, or if they are simply markers for more severe cardiac disease, such as left ventricular hypertrophy, that may independently predispose to SCD. Current obstacles that impair widespread implementation of ECG risk stratification in the hemodialysis population are also discussed.

    Original languageEnglish (US)
    Pages (from-to)848-854
    Number of pages7
    JournalJournal of Electrocardiology
    Issue number6
    StatePublished - Nov 1 2016


    • Arrhythmia
    • Cardiovascular disease
    • Conduction abnormality
    • Electrocardiogram
    • End stage renal disease
    • Hemodialysis
    • Sudden cardiac death

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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