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Author Notes:

Correspondence to: 550 Peachtree Street, NE, Atlanta, GA 30308, United States. Fax: þ404 686 4826. E-mail address: melcham@emory.edu (M.F. El-Chami).

Mikhael F. El-Chami is a consultant for Boston Scientific and Medtronic and has received a research grant from Medtronic.

The rest of the authors declare no conflicts of interest related to this study.

Subjects:

Keywords:

  • ESRD
  • ICD
  • Sudden cardiac death
  • Survival

Long-term survival of implantable cardioverter defibrillator recipients with end-stage renal disease

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Journal Title:

Journal of Arrhythmia

Volume:

Volume 33, Number 5

Publisher:

, Pages 459-462

Type of Work:

Article | Final Publisher PDF

Abstract:

The efficacy of implantable cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death (SCD) has not been studied in patients with end-stage renal disease (ESRD) and left ventricular dysfunction. We sought to identify predictors of long-term survival among ICD recipients with and without ESRD. Methods Patients implanted with an ICD at our institution from January 2006 to March 2014 were retrospectively identified. Clinical and demographic characteristics were collected. Patients were stratified by the presence of ESRD at the time of ICD implant. Mortality data were collected from the Social Security Death Index (SSDI). Results A total of 3453 patients received an ICD at our institution in the pre-specified time period, 184 (5.3%) of whom had ESRD. In general, ESRD patients were sicker and had more comorbidities. Kaplan Meier survival curve showed that ESRD patients had worse survival as compared with non-dialysis patients (p < 0.001). Following adjustment for differences in baseline characteristics, patients with ESRD remained at increased long-term mortality in the Cox model. The one-year mortality in the ESRD patients was 18.1%, as compared with 7.7% in the non-dialysis cohort (p < 0.001). The three-year mortality in ESRD patients was 43%, as compared with 21% in the non-dialysis cohort (p < 0.001). Conclusion ESRD patients are at significantly increased risk of mortality as compared with a non-dialysis cohort. While the majority of these patients survive more than one year post-diagnosis, the three-year mortality is high (43%). Randomized studies addressing the benefits of ICDs in ESRD patients are needed to better define their value for primary prevention of SCD.

Copyright information:

© 2017 Japanese Heart Rhythm Society. Published by Elsevier B.V.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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