Republished: How to reduce sudden cardiac death in patients with renal failure

Prevention of sudden cardiac death (SCD) is an important target for improving survival in various patient groups and many prevention options have been evaluated. In the past decade several trials have documented beneficial effects for implantable cardioverter-defibrillator (ICD) implantation in patients surviving out-of-hospital cardiac arrest (secondary prevention) and in patients with diminished left ventricular function (primary prevention).1 However, within these patient groups a variety of comorbidities is present which might influence the benefit conferred by prophylactic ICD implantation. One of these comorbidities is chronic kidney disease (CKD), a condition that is highly prevalent among patients with a current ICD indication. CKD is of particular interest since this condition is associated with a substantial risk for non-arrhythmic death and this might negatively influence the beneficial effects of prophylactic ICD implantation. Accordingly this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness.