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

• Authors: Mikhael El Chami, Emory University; Lea Matar, Emory University; Paige Smith, Emory University; Mary Casey, Emory University School of Medicine; Maher A. Addish, Boston Scientific; Kimberly Kelly, Emory University; Carolyn Wood, Emory University; John Merlino, Emory University; Abhinav Goyal, Emory University; Angel Leon, Emory University; Faisal Merchant, Emory University
• Journal Title: Journal of Arrhythmia
• Volume: Volume 33, Number 5
• Publisher: Elsevier | 2017-10, Pages 459-462
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.joa.2017.05.002
• Subjects: Biology, Physiology; Health Sciences, Public Health
• Keywords: ESRD; ICD; Sudden cardiac death; Survival

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.