Severe CKD (GFR < 30 mL/min) in ICD patients was associated with a 5-fold higher mortality risk and lower appropriate shock-free survival (2.8 vs 4.2 years) compared to mild or no CKD.
Cohort (n=509)
No
Does moderate to severe renal impairment increase mortality and appropriate shocks in patients with Implantable Cardioverter Defibrillators?
In patients with implantable cardioverter defibrillators, moderate to severe renal impairment is associated with significantly increased mortality, and severe CKD predicts a shorter time to first appropriate shock.
Estimación del efecto: RR 5.0 (severe CKD), RR 2.0 (moderate CKD)
Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000-2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30-59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30-59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.
Alla et al. (Fri,) conducted a cohort in Implantable Cardioverter Defibrillators and Chronic Kidney Disease (n=509). Moderate to severe chronic kidney disease vs. Mild or no chronic kidney disease (GFR ≥ 60 mL/min) was evaluated on Mortality and appropriate shocks (RR 5.0 (severe CKD), RR 2.0 (moderate CKD)). Severe CKD (GFR < 30 mL/min) in ICD patients was associated with a 5-fold higher mortality risk and lower appropriate shock-free survival (2.8 vs 4.2 years) compared to mild or no CKD.