What is the clinical evidence from this study?

Study design: Cohort. Population: Implantable Cardioverter-Defibrillator (ICD) recipients (n=46). Intervention: Hemodialysis vs. Non-hemodialysis. Primary outcome: Time to death (HR 2.9, p=0.023).

What question did this study set out to answer?

To determine whether implantable cardioverter-defibrillators provide the same mortality benefit to patients on hemodialysis compared to non-dialysis recipients.

August 21, 2007Pacing and Clinical Electrophysiology

Effect of End‐Stage Renal Failure and Hemodialysis on Mortality Rates in Implantable Cardioverter‐Defibrillator Recipients

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Key result

Among ICD recipients, patients on hemodialysis had a significantly higher two-year mortality rate than matched non-hemodialysis patients (54% vs 29%; adjusted HR 2.9, P=0.023).

Why the study?

Does hemodialysis increase mortality in implantable cardioverter-defibrillator recipients compared to matched non-hemodialysis patients?

Key Points

To determine whether implantable cardioverter-defibrillators provide the same mortality benefit to patients on hemodialysis compared to non-dialysis recipients.
Matched cohort of 46 ICD recipients (16 on hemodialysis, 30 non-hemodialysis controls) implanted between July 2001 and June 2004, matched by age, gender, left ventricular ejection fraction (LVEF), and heart failure class.
Patients were monitored for a mean follow-up of 30 ± 16 months (range, 4–61 months).
Multivariable Cox proportional hazards regression was used to adjust for age, gender, race, LVEF, heart failure class, and primary versus secondary ICD indication.
Overall mortality occurred in 12 of 16 (75%) hemodialysis patients compared to 9 of 30 (30%) non-hemodialysis controls (P = 0.006).
Two-year mortality rates reached 54% in the hemodialysis group versus 29% in the non-hemodialysis group (P = 0.01).
Hemodialysis independently predicted shorter time to death after adjusting for baseline characteristics and ICD indication (HR = 2.9, adjusted P = 0.023).

Study Design

Type

Cohort (n=46)

Structured PICO

Does hemodialysis increase mortality in implantable cardioverter-defibrillator recipients compared to matched non-hemodialysis patients?

Population

46 ICD recipients (16 on hemodialysis and 30 matched non-hemodialysis controls) with a mean age of 65 years, followed for a mean of 30 months.

Exposure

Hemodialysis (end-stage renal failure)

Comparator

Non-hemodialysis (matched by age, gender, LVEF, and class of heart failure)

Outcome

Mortality (time to death)hard clinical

Main Result

Hazard Ratio: 2.9

Absolute Event Rate: 54% vs 29%

p-value: p=0.023

Hemodialysis patients with an ICD have an approximately three-fold higher mortality risk compared to matched non-hemodialysis ICD recipients, suggesting they may not derive the same survival benefit from the device.

Limitations

Small sample size (authors note results need to be duplicated in larger randomized trials)

Discussion

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Implication

Warrants caution extrapolating ICD survival benefit to hemodialysis patients; extends prior observations but remains hypothesis-generating without randomized data.

Cite This Study

Hreybe et al. (2007) conducted a cohort in Implantable Cardioverter-Defibrillator (ICD) recipients (n=46). Hemodialysis vs. Non-hemodialysis was evaluated on Time to death (HR 2.9, p=0.023). Among ICD recipients, patients on hemodialysis had a significantly higher two-year mortality rate than matched non-hemodialysis patients (54% vs 29%; adjusted HR 2.9, P=0.023).

synapsesocial.com/papers/6a9909e519c7e0464f27382d https://doi.org/10.1111/j.1540-8159.2007.00818.x

Topics

Cardiac device therapy

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Implication

Warrants caution extrapolating ICD survival benefit to hemodialysis patients; extends prior observations but remains hypothesis-generating without randomized data.

Effect of End‐Stage Renal Failure and Hemodialysis on Mortality Rates in Implantable Cardioverter‐Defibrillator Recipients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Effect of End‐Stage Renal Failure and Hemodialysis on Mortality Rates in Implantable Cardioverter‐Defibrillator Recipients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider