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Implantable Cardioverter Defibrillators and Chronic Kidney Disease

James N Kiage, Zara Latif, Michael A Craig

    Current Problems in Cardiology
    |July 7, 2020
    PubMed

    Insights

    Implantable cardioverter defibrillators (ICDs) may offer fewer benefits for patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). These patients experienced more shocks and higher mortality, suggesting caution in routine ICD use for this population.

    Area of Science:

    • Cardiology
    • Nephrology
    • Medical Devices

    Background:

    • Implantable cardioverter defibrillators (ICDs) are standard for preventing sudden cardiac death in heart failure patients with low ejection fraction (<35%).
    • The efficacy and safety of ICDs in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) remain unclear.

    Purpose of the Study:

    • To systematically review existing literature on ICD use in patients with CKD or ESRD.
    • To evaluate the outcomes of ICD implantation in patients with varying degrees of kidney function.

    Main Methods:

    • A systematic review of studies from PubMed was performed.
    • 42 studies investigating ICD use in CKD/ESRD patients were selected from 470 identified articles.

    Main Results:

    • Patients with CKD/ESRD showed increased rates of antitachycardia pacing and shocks compared to those without kidney disease.
    • Higher cardiac and all-cause mortality was observed in CKD/ESRD patients receiving ICDs.
    • A dose-response relationship was noted, with worse outcomes correlating with declining kidney function.

    Conclusions:

    • ICD use in CKD/ESRD patients is linked to increased adverse events, including shocks and mortality.
    • Routine ICD implantation in this population may yield more harm than benefit.
    • Further research is needed to refine guidelines for ICD use in patients with kidney disease.

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