REN and Myocardial fibrosis: A study by Pun et al. showed that using standard cardiovascular medications (β-blockers, calcium-channel blockers, and renin-angiotensin system inhibitors) during dialysis-related SCA was associated with improved survival rates.27 Although most dialysis patients have normal or only mildly reduced ejection fraction, the prevalence of structural cardiac disease with left ventricular hypertrophy and myocardial fibrosis is high28 and may also contribute to SCA risk.