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Chronic kidney disease and mortality in implantable cardioverter-defibrillator recipients

Aamir Cheema1, Tejwant Singh, Manreet Kanwar

  • 1Division of Cardiology, Department of Medicine, St. John Hospital & Medical Center, 22101 Moross Road, Cardiac Cath Lab, Detroit, MI- 48236, USA.

Cardiology Research and Practice
|September 3, 2010
PubMed

Insights

Sudden cardiac death (SCD) risk is higher in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Implantable cardioverter-defibrillators (ICDs) show varied effectiveness based on CKD severity and device type.

Area of Science:

  • Nephrology
  • Cardiology
  • Medical Devices

Background:

  • Sudden cardiac death (SCD) is a significant concern in end-stage renal disease (ESRD) patients.
  • Data on the efficacy of implantable cardioverter-defibrillators (ICDs) in preventing arrhythmic death in chronic kidney disease (CKD) patients is limited.

Purpose of the Study:

  • To investigate the impact of CKD on all-cause mortality and SCD in patients receiving ICDs.
  • To compare outcomes across different stages of CKD, including ESRD on hemodialysis.

Main Methods:

  • Retrospective analysis of 441 consecutive patients undergoing ICD implantation between 1994 and 2002.
  • Stratification of patients based on estimated glomerular filtration rate (eGFR) and dialysis status.

Main Results:

  • Higher mortality rates were observed in patients with eGFR <60 mL/min (43%) and ESRD on hemodialysis (54%) compared to those with eGFR ≥60 mL/min (23%).
  • SCD rate was significantly higher in ESRD patients (50%) versus non-dialysis CKD patients (10.2%).
  • Mortality rates varied by ICD type: single-chamber (56.8%), dual-chamber (38.1%), and biventricular (5.0%).

Conclusions:

  • CKD, particularly ESRD, is associated with increased mortality and SCD risk in ICD recipients.
  • Biventricular ICDs appear to offer superior survival benefits in this patient population compared to single or dual-chamber devices.

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