Chronic kidney disease was associated with a significantly higher mortality risk in patients receiving implantable cardioverter defibrillator therapy (HR 3.44; 95% CI 2.82-4.21; P<0.001).
Meta-Analysis (n=3,010)
Does chronic kidney disease increase mortality in patients receiving implantable cardioverter defibrillator therapy?
Chronic kidney disease is associated with a more than three-fold increased risk of mortality in patients receiving implantable cardioverter defibrillators, highlighting the need for better risk stratification in this population.
Effect estimate: HR 3.44 (95% CI 2.82-4.21)
p-value: p=<0.001
AIMS: Recent observational studies have shown that implantable cardioverter defibrillator (ICD) patients with chronic kidney disease (CKD) have increased mortality and therefore the value of device therapy in this group has been questioned. The purpose of this meta-analysis was to systematically analyse the effect of renal dysfunction on mortality of ICD patients. METHODS AND RESULTS: Pubmed, Cochrane clinical trials database, and EMBASE were searched until December 2008. In addition, a manual search was performed using review articles, reference lists of papers, and abstracts from conference reports. Of the 90 initially identified studies, 11 observational studies with 3010 patients were analysed. The meta-analysis of these studies showed that CKD was associated with higher mortality risk (HR = 3.44, 95% CI 2.82-4.21, Z = 12.09, P < 0.001) while there were no significant differences between individual trials (P = 0.09, I(2) = 37.8%). A subgroup analysis which included the four studies that used estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) to define CKD showed a higher mortality in the CKD group as well (HR = 3.06, 95% CI 2.31-4.04, Z = 7.84, P < 0.001) without significant heterogeneity (P = 0.38, I(2) = 5.2%). CONCLUSION: Our meta-analysis suggests that CKD is associated with increased mortality in patients who receive ICD therapy. Undoubtedly, prospective studies are needed in order to elucidate the impact of different stages of CKD in this setting. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of ICD therapy candidates.
Korantzopoulos et al. (Tue,) conducted a meta-analysis in Implantable cardioverter defibrillator patients with chronic kidney disease (n=3,010). Chronic kidney disease (exposure) vs. No chronic kidney disease was evaluated on Mortality (HR 3.44, 95% CI 2.82-4.21, p=<0.001). Chronic kidney disease was associated with a significantly higher mortality risk in patients receiving implantable cardioverter defibrillator therapy (HR 3.44; 95% CI 2.82-4.21; P<0.001).