??????????
GreenbergandChoi
ratesalsoseemsreasonable.Morefrequentdialysis(onlythoroughevaluationshouldbeconductedtoprevent
feasibleinthehomeHDsetting)hasbeenshowntoreducefurtherevents.Rootcauseanalysisisaprocessthatis
leftventricularhypertrophy;morefrequentdialysisalsowidelyusedforqualityimprovement.Itprovidesastruc-
likelyreducessigni?cant?uidandelectrolyteshiftsbyturedframeworkforidentifyingoneormorerootcauses
eliminatingthelonginterdialyticperiod.Giventhethatledtoanadverseoutcomeanddeterminechangesthat
recentlyidenti?edprevalenceofbradyarrhythmias,pace-canbeimplementedimproveperformance.Manyin-
makersmayhavearole,althoughkidneyfailurepatientsstitutions,includingtheCentersforMedicare&Medicaid
havehighercomplicationratesfollowingpacemakerorServices,haveprovidedguidanceforconductingroot
implantablecardioverterde?brillator(ICD)implantationcauseanalysis.
comparedtonondialysispatients.Similarly,theroleof
ICDsinkidneyfailureisuncertain,evenforsecondary
AdditionalReadings
preventioninpatientswithahistoryofventricular?bril-
CentersforMedicare&MedicareServices.GuidanceforPer-
lation.Possiblestrategiesforpreventionofsuddencardiac
formingRootCauseAnalysis(RCA)withPerformance
deatharelistedinTable2.ImprovementProjects(PIP).AccessedNovember9,2020.
https://www.cms.gov/Medicare/Provider-Enrollment-and-
Certication/QAPI/downloads/GuidanceforRCA.pdf.
AdditionalReadings
MakarMS,PunPH.Suddencardiacdeathamonghemodialysis
patients.AmJKidneyDis.2017;69(5):684-695.
ArticleInformation
SamantaR,ChanC,ChauhanVS.Arrhythmiasandsudden
cardiacdeathinendstagerenaldisease:epidemiology,risk
Authors’FullNamesandAcademicDegrees:KeikoI.Greenberg,
factors,andmanagement.CanJCardiol.2019;35(9):1228-40.MD,MHS,andMichaelJ.Choi,MD
+ESSENTIALREADING
Authors’Afliation:MedStarGeorgetownUniversityHospital,
Roy-ChaudhuryP,TumLinJA,KoplanBA,etal.Primaryoutcomes
Washington,DC.
oftheMonitoringinDialysisStudyindicatethatclinicallysignicant
AddressforCorrespondence:MichaelJ.Choi,MD,MedStar
arrhythmiasarecommoninhemodialysispatientsandrelatedto
GeorgetownUniversityHospital,3800ReservoirRoadNW,PHC
dialyticcycle.KidneyInt.2018;93(4):941-951.
6,F6003,Washington,DC20007.Email:michael.choi@gunet.
TumLinJA,Roy-ChaudhuryP,KoplanBA,etal.Relationship
georgetown.edu
betweendialyticparametersandreviewerconrmedarrhythmias
Support:None.
inhemodialysispatientsinthemonitoringindialysisstudy.BMC
FinancialDisclosure:Theauthorsdeclarethattheyhaveno
Nephrol.2019;20(1):80.
relevantnancialinterests.
PeerReview:ReceivedJune24,2020inresponsetoaninvitation
fromthejournal.Evaluatedby2externalpeerreviewersanda
RootCauseAnalysis
memberoftheFeatureAdvisoryBoard,withdirecteditorialinput
TheHDemergenciesdiscussedinthisarticlearesumma-
fromtheFeatureEditorandaDeputyEditor.Acceptedinrevised
rizedinTable3.ShouldanyHDcomplicationoccur,aformNovember10,2020.
14AJKDVolXX|IssXX|Month2021
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