Prophylactic Use of Implantable Cardioverter-Defibrillators in the Prevention of Sudden Cardiac Death in Dialysis Patients
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Why the study?
Patients with end-stage renal disease undergoing dialysis are at high risk of sudden cardiac death, but no therapy has been shown to reduce this risk and the value of prophylactic ICDs remains uncertain.
Does prophylactic implantable cardioverter-defibrillator therapy reduce sudden cardiac death in patients on dialysis with LVEF ≥35%?
Population
188 dialysis patients with left ventricular ejection fraction ≥35%
Comparison
Prophylactic ICD implantation vs control
Design
Prospective randomized controlled trial
Follow-up
Median 6.8 years
Authors
Discussion
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Member takes
Implication
Prophylactic ICDs do not reduce SCD in dialysis patients; leaves open optimal prevention strategies in this high-risk population.
Structured PICO
Does prophylactic implantable cardioverter-defibrillator therapy reduce sudden cardiac death in patients on dialysis with LVEF ≥35%?
P
Population
188 patients aged 55-80 years with end-stage renal disease treated with hemodialysis or peritoneal dialysis for ≥90 days and left ventricular ejection fraction ≥35%. Median age 67, 76.1% men. Excluded: class I indication for ICD, NYHA class IV, life expectancy <1 year, central venous catheter, living kidney donation preparation, acute myocardial infarction in past 40 days, or HIV.
I
Intervention
Prophylactic implantable cardioverter-defibrillator (ICD) implantation (Biotronik device, mostly dual-chamber) added to usual care.
C
Comparator
Usual care (no ICD).
O
Outcome
Sudden cardiac (arrhythmic) death, adjudicated by a blinded clinical events committee.hard clinical
In patients on dialysis with LVEF ≥35%, prophylactic ICD implantation did not reduce sudden cardiac death or all-cause mortality and was associated with significant device-related complications.
Limitations
- Stopped early for futility
Cite This Study
Jukema et al. (2019) studied this question.
Topics
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