Letter to the Editor
Sudden death in patients with advanced chronic renal disease
Muerte súbita en pacientes con enfermedad renal crónica avanzada
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con un líquido de diálisis con citrato que con acetato" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1240 "Ancho" => 1448 "Tamanyo" => 77229 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Concentrations of calcium in the blood (mmol/L) entering and leaving the dialyser, with the different components. Ionized calcium plus that bound to citrate and bicarbonate form the diffusible calcium in blood; all DF calcium is diffusible. Note that the concentration of blood-diffusible calcium is greater than that of the DF leaving the dialyser.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Pérez-García, Marta Albalate, Patricia De Sequera, Mayra Ortega" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Pérez-García" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Albalate" ] 2 => array:2 [ "nombre" => "Patricia" "apellidos" => "De Sequera" ] 3 => array:2 [ "nombre" => "Mayra" "apellidos" => "Ortega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301539" "doi" => "10.1016/j.nefro.2016.09.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301539?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300299?idApp=UINPBA000064" "url" => "/20132514/0000003700000001/v1_201703230033/S2013251417300299/v1_201703230033/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Sudden death in patients with advanced chronic renal disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "111" "paginaFinal" => "112" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen Sánchez Perales, Eduardo Vázquez Ruiz de Castroviejo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "Sánchez Perales" "email" => array:1 [ 0 => "mcsanchezp@senefro.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Vázquez Ruiz de Castroviejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Cardiología, Complejo Hospitalario de Jaén, Jaén, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Muerte súbita en pacientes con enfermedad renal crónica avanzada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the article by Caravaca et al. entitled “Sudden death in patients with advanced chronic kidney disease”<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and we would first like to congratulate the authors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is a subject of great interest among both kidney failure patients and the general population, which is a cause for social concern and requires a complex approach.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We believe its complexity is based on several factors. The first is the definition of sudden death (SD) itself. The one used by the authors is the most widely accepted and includes natural death occurring within an hour of the onset of symptoms, although they also include unexplained death during sleep. The latter definition can be assimilated to those that propose other time intervals (2, 6 and 24<span class="elsevierStyleHsp" style=""></span>h) between the onset of symptoms and death for specific circumstances such as unwitnessed death, which reduce the probability of heart-related death the longer the time that elapses between death and the onset of symptoms.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> This variability in the time period in question is one of the factors that contribute to the differences found in the prevalence of SD in different studies. Caravaca et al. found an annual incidence of 1.8%, not including that of death during sleep. In a study conducted at our hospital on a dialysis population, the annual incidence was 1.7% when we considered an interval of one hour, and 2.9% when the interval was extended to 24<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The lack of autopsies in the Caravaca et al. study, as in ours (something that was particularly inexplicable for the reviewers of the American journal in which it was published), poses many obstacles when it comes to establishing the cause of death. In a Japanese study in which autopsy was performed on 81.4% of patients who had SD, strokes and aortic dissection accounted for more than 45% of the causes of death.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another aspect to be taken into account when analysing SD is the need to search for those factors that identify the population at greatest risk in order to come up with targeted and profitable prevention strategies. Caravaca et al. found through Cox regression analysis that greater age and greater comorbidity were associated with a higher probability of SD, and the use of antiplatelet therapy had a protective effect. In our study,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> with the same analysis, we identified a combined variable that included a documented history of coronary disease and electrocardiographic abnormalities (abnormal Q waves, subendocardial lesion, negative T-wave and QRS >120<span class="elsevierStyleHsp" style=""></span>ms) which clearly identified two risk groups. Patients who had none of the aforementioned findings had almost the same probability of SD as the general population; however, those who had one of them had a probability of SD similar to that shown by patients in the general population with left ventricular dysfunction and who have been included in studies demonstrating the efficacy of the automatic implantable defibrillator.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> The lack of availability of electrocardiography records in the Caravaca et al. study, which the authors point out as a limitation, makes it impossible to verify whether the findings of our study can be extrapolated to a renal insufficiency population that is not on dialysis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study by Caravaca et al. provides information and raises awareness of the importance of the problem and urges the scientific community and the health authorities to establish measures. The first of these is to give a precise definition of SD in all registers in order to reduce variability between centres. The need to perform autopsies in cases of unexpected, unexplained deaths, even in patients with severe chronic diseases, is undoubtedly an aspect that should be given greater attention.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, the identification of risk subgroups does not necessarily mean that we can extrapolate the prevention strategies that have been shown to be effective in the general population. The automatic implantable defibrillator is less effective in patients with kidney failure,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and even something as basic as having external defibrillators in dialysis units also has a limited efficacy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we again congratulate Caravaca et al. for their contributions to an important issue that has so far not been given the attention it deserves.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez Perales C, Vázquez Ruiz de Castroviejo E. Muerte súbita en pacientes con enfermedad renal crónica avanzada. Nefrologia. 2017;37:111–112.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Muerte súbita en pacientes con enfermedad renal crónica avanzada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Caravaca" 1 => "E. Chávez" 2 => "R. Alvarado" 3 => "G. García-Pino" 4 => "E. 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| 2024 June | 62 | 30 | 92 |
| 2024 May | 40 | 33 | 73 |
| 2024 April | 49 | 32 | 81 |
| 2024 March | 40 | 28 | 68 |
| 2024 February | 34 | 39 | 73 |
| 2024 January | 39 | 22 | 61 |
| 2023 December | 47 | 25 | 72 |
| 2023 November | 45 | 29 | 74 |
| 2023 October | 59 | 27 | 86 |
| 2023 September | 63 | 29 | 92 |
| 2023 August | 49 | 23 | 72 |
| 2023 July | 36 | 24 | 60 |
| 2023 June | 79 | 17 | 96 |
| 2023 May | 116 | 30 | 146 |
| 2023 April | 67 | 15 | 82 |
| 2023 March | 99 | 19 | 118 |
| 2023 February | 63 | 19 | 82 |
| 2023 January | 27 | 23 | 50 |
| 2022 December | 39 | 24 | 63 |
| 2022 November | 48 | 26 | 74 |
| 2022 October | 30 | 36 | 66 |
| 2022 September | 40 | 22 | 62 |
| 2022 August | 41 | 49 | 90 |
| 2022 July | 33 | 44 | 77 |
| 2022 June | 29 | 29 | 58 |
| 2022 May | 33 | 23 | 56 |
| 2022 April | 27 | 46 | 73 |
| 2022 March | 41 | 38 | 79 |
| 2022 February | 35 | 37 | 72 |
| 2022 January | 26 | 27 | 53 |
| 2021 December | 45 | 46 | 91 |
| 2021 November | 29 | 34 | 63 |
| 2021 October | 32 | 48 | 80 |
| 2021 September | 31 | 35 | 66 |
| 2021 August | 28 | 40 | 68 |
| 2021 July | 31 | 28 | 59 |
| 2021 June | 28 | 21 | 49 |
| 2021 May | 38 | 42 | 80 |
| 2021 April | 98 | 81 | 179 |
| 2021 March | 47 | 30 | 77 |
| 2021 February | 22 | 20 | 42 |
| 2021 January | 28 | 16 | 44 |
| 2020 December | 26 | 16 | 42 |
| 2020 November | 24 | 16 | 40 |
| 2020 October | 12 | 17 | 29 |
| 2020 September | 20 | 14 | 34 |
| 2020 August | 34 | 12 | 46 |
| 2020 July | 16 | 9 | 25 |
| 2020 June | 26 | 16 | 42 |
| 2020 May | 23 | 12 | 35 |
| 2020 April | 23 | 16 | 39 |
| 2020 March | 25 | 10 | 35 |
| 2020 February | 27 | 22 | 49 |
| 2020 January | 36 | 17 | 53 |
| 2019 December | 24 | 20 | 44 |
| 2019 November | 33 | 20 | 53 |
| 2019 October | 14 | 10 | 24 |
| 2019 September | 26 | 15 | 41 |
| 2019 August | 24 | 15 | 39 |
| 2019 July | 20 | 21 | 41 |
| 2019 June | 34 | 16 | 50 |
| 2019 May | 20 | 11 | 31 |
| 2019 April | 47 | 27 | 74 |
| 2019 March | 40 | 25 | 65 |
| 2019 February | 19 | 20 | 39 |
| 2019 January | 29 | 21 | 50 |
| 2018 December | 124 | 44 | 168 |
| 2018 November | 230 | 18 | 248 |
| 2018 October | 258 | 20 | 278 |
| 2018 September | 100 | 24 | 124 |
| 2018 August | 97 | 19 | 116 |
| 2018 July | 99 | 21 | 120 |
| 2018 June | 96 | 11 | 107 |
| 2018 May | 107 | 17 | 124 |
| 2018 April | 146 | 10 | 156 |
| 2018 March | 128 | 9 | 137 |
| 2018 February | 169 | 10 | 179 |
| 2018 January | 58 | 4 | 62 |
| 2017 December | 117 | 6 | 123 |
| 2017 November | 45 | 7 | 52 |
| 2017 October | 37 | 5 | 42 |
| 2017 September | 38 | 8 | 46 |
| 2017 August | 52 | 6 | 58 |
| 2017 July | 45 | 5 | 50 |
| 2017 June | 45 | 6 | 51 |
| 2017 May | 60 | 12 | 72 |
| 2017 April | 34 | 7 | 41 |
| 2017 March | 46 | 7 | 53 |
| 2017 February | 6 | 1 | 7 |
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