Clinical characteristics and in-hospital outcome of patients with end-stage renal disease on dialysis referred for implantable cardioverter-defibrillator implantation

Abstract

Background: Little is known about the clinical profile of end-stage renal disease (ESRD) patients who undergo implantable cardioverter-defibrillator (ICD) implantation.

Objective: This study sought to analyze the risk profile of ESRD patients admitted for ICD implantation.

Methods: Patients undergoing first-time device implantation in National Cardiovascular Data Registry/ICD registry from 01/01/06 to 12/31/07 were analyzed (n = 164,069). Patients with ESRD (defined as those requiring dialysis) were compared with patients without ESRD. Primary outcome was in-hospital complications. Because length of hospital stay for ERSD patients was significantly longer (8 vs. 4 days), complications within 2 days of ICD implantation were also examined. The proportion of patients meeting approved indications for ICD implantation was evaluated.

Results: ESRD patients (n = 6,851, 4.4%) had higher rates of comorbid medical conditions, major complications, and total complications, and were less likely to receive an ICD for primary prevention. ESRD patients who received ICD implantation for primary prevention were more likely to meet trial criteria. ESRD patients were less likely to receive beta-blockers and angiotensin inhibitors (P <.0001). Unadjusted in-hospital mortality was almost 5-fold among patients with ESRD (1.9% vs. 0.4%, P <.0001). Multivariable analysis confirmed that ESRD was independently associated with total in-hospital complications (odds ratio [OR] = 1.38, 95% confidence interval: 1.23 to 1.54, P <.0001), and total complications at 2 days (OR = 1.20, 95% confidence interval: 1.05 to 1.36, P = .006).

Conclusion: ESRD patients presenting for ICD implantation are sicker, and have higher rates of in-hospital complications even when accounting for overall longer length of hospital stay. Strategies to decrease complications among ESRD patients who undergo ICD implantation need exploration.