Sudden Cardiac Arrest in Haemodialysis Patients: Clinical Features and Risk Factors

Sudden cardiac arrest (SCA) and its often fatal consequence, sudden cardiac death (SCD), represent the single most important cause of mortality among patients maintained on maintenance haemodialysis, accounting for approximately 25–27% of all-cause deaths in this population. The risk of SCD in haemodialysis patients is estimated to be 20 to 30 times higher than in the general population, yet the underlying pathophysiology and optimal preventive strategies remain incompletely understood and actively debated. Unlike in the general population, where ischaemic cardiomyopathy with reduced left ventricular ejection fraction constitutes the principal substrate for fatal arrhythmia, haemodialysis patients exhibit a distinctive constellation of structural, electrophysiological, and dialysis-procedure-related risk factors that render traditional cardiovascular risk stratification tools inadequate. This review synthesises current evidence on the epidemiology, clinical presentation, pathophysiological mechanisms, and modifiable and non-modifiable risk factors for SCA in the haemodialysis population. A systematic approach was employed to identify relevant literature for this narrative review. Electronic searches were conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, covering publications since January 1996. The roles of left ventricular hypertrophy, vascular calcification, autonomic dysfunction, electrolyte dysregulation, and dialysis prescription characteristics are examined in detail. The temporal pattern of SCA—with peak incidence on the day following the long interdialytic weekend interval—highlights the unique contribution of the haemodialysis procedure itself. Evidence regarding preventive strategies, including modification of dialysate composition, pharmacotherapy, and device-based interventions such as implantable cardioverter-defibrillators, is critically evaluated. Despite substantial research activity, significant gaps remain in risk stratification and the development of evidence-based prevention protocols tailored to this uniquely vulnerable population.