February 1, 2007Pacing and Clinical Electrophysiology
Poor Prognosis for Patients with Chronic Kidney Disease Despite ICD Therapy for the Primary Prevention of Sudden Death
Key result
In patients receiving an ICD for primary prevention of sudden death, chronic kidney disease was associated with significantly higher mortality (48.6% vs 8.2%; HR 10.5; 95% CI 4.8-23.1; P=0.0001).
Authors
Discussion
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Member takes
Implication
CKD signals markedly higher post-ICD mortality; leaves open whether primary-prevention devices improve survival in this subgroup.
Key Points
- To evaluate the impact of chronic kidney disease on survival among patients receiving an implantable cardioverter defibrillator for the primary prevention of sudden death.
- Retrospective analysis of 229 patients receiving an implantable cardioverter defibrillator for primary sudden death prevention, with a follow-up of 18.0 ± 15.2 months.
- Patients were stratified by chronic kidney disease, defined as serum creatinine ≥ 2 mg/dL or dialysis dependence.
- Mortality reached 48.6% (17/35) in patients with chronic kidney disease compared with 8.2% (16/194) in those without (P < 0.00001), yielding 1-year survival rates of 61.2% versus 96.3%.
- Chronic kidney disease was the strongest independent predictor of mortality (HR 10.5, 95% CI 4.8–23.1, P = 0.0001), with every 10 mL/min decline in creatinine clearance linked to a 55% increase in hazard of death (P < 0.0001).
Study Design
Type
Cohort (n=229)
PICO
P
Population
229 patients who underwent ICD implantation for primary prevention of sudden death, followed for a mean of 18.0 months.
E
Exposure / Comparator
Chronic kidney disease (CKD) vs No chronic kidney disease
O
Primary Outcome
mortality — HR 10.5 (4.8-23.1), p=0.0001
Main Result
Hazard Ratio: 10.5 (95% CI 4.8–23.1)
Absolute Event Rate: 48.6% vs 8.2%
p-value: p=0.0001
Cite This Study
Cuculich et al. (2007) conducted a cohort in Patients receiving an ICD for primary prevention of sudden death (n=229). Chronic kidney disease (CKD) vs. No chronic kidney disease was evaluated on mortality (HR 10.5, 95% CI 4.8-23.1, p=0.0001). In patients receiving an ICD for primary prevention of sudden death, chronic kidney disease was associated with significantly higher mortality (48.6% vs 8.2%; HR 10.5; 95% CI 4.8-23.1; P=0.0001).