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. 2020 Aug 15;11(8):4199-4208.
doi: 10.19102/icrm.2020.110803. eCollection 2020 Aug.

Efficacy of Implantable Cardioverter-defibrillators for Secondary Prevention of Sudden Cardiac Death in Patients with End-stage Renal Disease

Taylor Payne  1 , Jennifer Waller  2 , Mufaddal Kheda  1 , N Stanley Nahman Jr  1 , Joyce Maalouf  1 , Aaron Gopal  1 , Haitham Hreibe  1
Affiliations

Efficacy of Implantable Cardioverter-defibrillators for Secondary Prevention of Sudden Cardiac Death in Patients with End-stage Renal Disease

Taylor Payne et al. J Innov Card Rhythm Manag. .

Abstract

End-stage renal disease (ESRD) constitutes a major burden on the health-care system in the United States, with more than 300,000 patients nationwide being treated with renal replacement therapy. Very few studies to date have evaluated the benefit of implantable cardioverter-defibrillator (ICD) implantation for secondary prevention in patients with ESRD. In this study, we evaluated the efficacy of secondary-prevention ICDs in reducing all-cause mortality in patients on dialysis using the United States Renal Data System (USRDS) database. We queried the USRDS for relevant data between 2004 and 2010. Patients with diagnoses of ventricular fibrillation (VF), ventricular tachycardia (VT), or sudden cardiac arrest (SCA) were included in the study. Patients were excluded from the analysis if they were younger than 18 years; had missing age, sex, or race/ethnicity information; had experienced myocardial infarction; or had an ICD in situ at the time of VF, VT, or SCA diagnosis. The primary endpoint of this study was to determine the efficacy of secondary-prevention ICDs in reducing all-cause mortality in patients on dialysis. A total of 1,442 patients (3.4%) with ESRD had ICD insertion. Patients who received an ICD were predominantly younger, white males with lower Charlson Comorbidity Index and with fewer cardiovascular events. Survival at two years was 53% among those with an ICD relative to 27% among those without an ICD. In this study, we observed a substantial decrease in mortality in patients receiving an ICD for secondary prevention when compared with a cohort of similar patients with a history of VF, VT, or SCA.

Keywords: End-stage renal disease; implantable cardioverter-defibrillator; secondary prevention; sudden cardiac arrest; sudden cardiac death.

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Conflict of interest statement

The authors report no conflicts of interest for the published content. This study was supported by a reserve fund research grant from Dialysis Clinic, Inc. (awarded to M.K. and N.S.N.) and by the Translational Research Program of the Department of Medicine.

Figures

Figure 1:
Figure 1:
Product-limit survival estimates, with the number of subjects at risk.
Figure 2:
Figure 2:
The aHR of ICD insertion and other risk factors for mortality.
Figure 3:
Figure 3:
aHR of risk factors for mortality among those with ICD insertion.
See this image and copyright information in PMC

References

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