Aldosterone and Cortisol affect the risk of sudden cardiac death in hemodialysis patients

BackgroundSudden cardiac death is common and accounts to a large extent for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients.MethodsWe analyzed data from 1255 hemodialysis patients with type 2 diabetes mellitus, participating in the German Diabetes and Dialysis Study (4D Study). Aldosterone (<15pg/mL; 15–100pg/mL, 100–200pg/mL, >200pg/mL), and cortisol (quartiles) were determined at baseline and patients were followed up for a median of 4 years. By Cox regression analyses hazard ratios (HR) were determined for the effect of aldosterone, cortisol and its combination on sudden death and other cardiovascular outcomes.ResultsThe mean age of the patients was 66±8 years (54% male). The median levels of aldosterone was 15pg/mL and of cortisol 16.8μg/dL. Patients with aldosterone levels >200pg/mL had a significantly higher risk of sudden death (HR 1.69; 95% CI 1.06-2.69) compared to those with an aldosterone <15pg/mL. The combined presence of high aldosterone (>200pg/mL) and high cortisol (>21.1μg/dL) levels increased the risk of sudden cardiac death strikingly compared to patients with low aldosterone (<15pg/mL) and low cortisol (