Implantable cardioverter-defibrillators in dialysis patients

​Patients with end-stage renal disease on dialysis are at a high risk of sudden cardiac death (SCD). The Implantable Cardioverter-Defibrillator in Dialysis Patients (ICD-2) trial studied the role of the primary prevention ICD in preventing death in dialysis patients with a left ventricular ejection fraction (LVEF) ≥35%. Compared with the general population, annual mortality rates are over 10-fold higher in patients with end-stage renal disease undergoing dialysis.1 A large proportion of deaths in dialysis patients are attributed to SCD.2 The annual incidence of SCD in haemodialysis patients is between 5% and 7%, compared with 4% in patients with heart failure, and 1.5%–2.7% in patients with chronic kidney disease not requiring dialysis.2 The increased risk of SCD is ascribed to a combination of proarrhythmogenic factors, including dialysis-induced haemodynamic stress and myocardial ischaemia, electrolyte and fluid shifts, left ventricular hypertrophy and fibrosis, and autonomic dysregulation.2 3 A number of clinical trials have previously identified groups of patients at high risk of SCD who gain a mortality benefit from the insertion of an …