Survival after primary prevention implantable cardioverter-defibrillator placement among patients with chronic kidney disease

Paul L. Hess, Anne S. Hellkamp, Eric D. Peterson, Gillian D. Sanders, Hussein R. Al-Khalidi, Lesley H. Curtis, Bradley G. Hammill, Patrick H. Pun, Jeptha P. Curtis, Kevin J. Anstrom, Stephen C. Hammill, Sana M. Al-Khatib

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD). Methods and Results: Using the National Cardiovascular Data Registry ICD registry linked with the Social Security Death Master File, we assessed the rate of death after primary prevention ICD placement between January 1, 2006, and December 31, 2007, according to CKD stage. Using Cox models, we identified factors associated with death among patients with CKD. Compared with patients without CKD (n=26 056), those with CKD (n=21 226) were older, less commonly men, more often white, and more frequently had comorbid illness. Compared with patients without CKD, patients with a glomerular filtration rate 30 to 60, glomerular filtration rate <30, and end-stage renal disease on dialysis had a higher risk of death after ICD placement (hazard ratio, 2.08; 95% confidence interval, 1.99-2.18; P<0.0001; hazard ratio, 4.20; 95% confidence interval, 3.92-4.50; P<0.0001; and hazard ratio, 4.80; 95% confidence interval, 4.46-5.17; P<0.0001, respectively). Corresponding 1-year death rates were 4.4%, 9.1%, 20.2%, and 22.4%. Among patients with CKD, factors associated with increased risk of death included CKD severity, age >65 years, heart failure symptoms, diabetes mellitus, lung disease, serum sodium <140 mEq/L, atrial fibrillation or flutter, and a lower ejection fraction. Conclusions: The risk of death after primary prevention ICD placement is proportional to CKD severity. Among patients with CKD, several factors are prognostically significant and could inform clinical decision making on primary prevention ICD candidacy.

Original languageEnglish (US)
Pages (from-to)793-799
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number5
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • chronic
  • defibrillators
  • Implantable
  • Renal insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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