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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Implantable cardioverter defibrillator therapy in chronic kidney disease: a meta-analysis

Panagiotis Korantzopoulos1, Tong Liu, Lijian Li

  • 1Department of Cardiology, University of Ioannina Medical School, 45110 Ioannina, Greece. p.korantzopoulos@yahoo.gr

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|October 9, 2009
PubMed

Insights

Chronic kidney disease (CKD) significantly increases mortality risk in patients receiving implantable cardioverter defibrillator (ICD) therapy. Further research is needed to refine risk stratification for these individuals.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Epidemiology

Background:

  • Observational studies indicate higher mortality in implantable cardioverter defibrillator (ICD) patients with chronic kidney disease (CKD).
  • The clinical utility of ICD therapy in patients with renal dysfunction has been questioned due to these findings.

Purpose of the Study:

  • To systematically analyze the impact of renal dysfunction on mortality in patients undergoing ICD therapy.
  • To provide a quantitative assessment of the association between CKD and mortality in ICD recipients.

Main Methods:

  • A comprehensive meta-analysis of published observational studies was conducted.
  • Searches were performed in PubMed, Cochrane clinical trials database, and EMBASE up to December 2008, supplemented by manual searches.
  • Eleven studies comprising 3010 patients were included in the final analysis.

Main Results:

  • The meta-analysis revealed a significantly higher mortality risk in ICD patients with CKD (HR = 3.44, 95% CI 2.82-4.21).
  • Subgroup analysis of studies using estimated GFR <60 mL/min/1.73 m(2) to define CKD also showed increased mortality (HR = 3.06, 95% CI 2.31-4.04).
  • No significant heterogeneity was observed within the overall analysis (I(2) = 37.8%) or the subgroup analysis (I(2) = 5.2%).

Conclusions:

  • Chronic kidney disease is strongly associated with increased mortality in patients receiving ICD therapy.
  • Prospective studies are essential to clarify the influence of different CKD stages on outcomes.
  • Improved risk stratification strategies are imperative for selecting appropriate candidates for ICD therapy, given the rising prevalence of CKD.
Abstract

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