Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients

Jason Robin, Kenneth Weinberg, Jay Tiongson, Mercedes Carnethon, Madhavi Reddy, Christina Ciaccio, Michael Quadrini, Jonathan Hsu, John Fan, Patrick Choi, Alan Kadish, Jeffrey Goldberger, Rod Passman

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Patients with end-stage renal disease are at increased risk for sudden cardiac death, although the utility of implantable cardioverter-defibrillators (ICDs) in these patients is unknown. Objectives: The purpose of this study was to evaluate whether end-stage renal disease is an independent risk factor for appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) and to compare the long-term survival of ICD recipients with and without end-stage renal disease. Methods: A retrospective cohort study was performed on ICD recipients at a single center. The primary endpoint was first appropriate ICD therapy for VT/VF. The secondary endpoint was survival. Results: The study included 585 patients, 19 (3.2%) of whom had end-stage renal disease prior to device implantation. Average follow-up time was 2.2 ± 2.4 years, during which time 156 patients (26.7%) received appropriate ICD therapy. End-stage renal disease was strongly associated with appropriate ICD therapy (hazard ratio 2.30, 95% confidence interval 1.17-4.54) and remained a significant predictor following adjustment for implant indication, ejection fraction, diabetes, hypertension, and beta-blocker use. Survival was significantly shorter in the end-stage renal disease patients, with a median survival time of 3.2 ± 0.6 (SEM) years in the dialysis cohort and 7.4 ± 0.5 (SEM) years in those without end-stage renal disease (log rank P = .009). The majority of deaths in the end-stage renal disease cohort were due to non-device-related infection. Conclusion: In this cohort, end-stage renal disease was the single greatest predictor of ICD therapies for VT/VF. The survival rate was significantly shorter than that of ICD recipients without end-stage renal disease, suggesting that comorbidities in end-stage renal disease patients meeting current implant indications may reduce the survival benefit of ICD placement in this population.

Original languageEnglish (US)
Pages (from-to)1196-1201
Number of pages6
JournalHeart Rhythm
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2006
Externally publishedYes

Fingerprint

Implantable Defibrillators
Chronic Kidney Failure
Renal Dialysis
Mortality
Ventricular Fibrillation
Ventricular Tachycardia
Survival
Therapeutics
Sudden Cardiac Death
Comorbidity
Dialysis
Cohort Studies
Survival Rate
Retrospective Studies
Confidence Intervals
Hypertension

Keywords

  • Dialysis
  • End-stage renal disease
  • Implantable cardioverter-defibrillator
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Robin, J., Weinberg, K., Tiongson, J., Carnethon, M., Reddy, M., Ciaccio, C., ... Passman, R. (2006). Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. Heart Rhythm, 3(10), 1196-1201. https://doi.org/10.1016/j.hrthm.2006.06.013

Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. / Robin, Jason; Weinberg, Kenneth; Tiongson, Jay; Carnethon, Mercedes; Reddy, Madhavi; Ciaccio, Christina; Quadrini, Michael; Hsu, Jonathan; Fan, John; Choi, Patrick; Kadish, Alan; Goldberger, Jeffrey; Passman, Rod.

In: Heart Rhythm, Vol. 3, No. 10, 01.10.2006, p. 1196-1201.

Research output: Contribution to journalArticle

Robin, J, Weinberg, K, Tiongson, J, Carnethon, M, Reddy, M, Ciaccio, C, Quadrini, M, Hsu, J, Fan, J, Choi, P, Kadish, A, Goldberger, J & Passman, R 2006, 'Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients', Heart Rhythm, vol. 3, no. 10, pp. 1196-1201. https://doi.org/10.1016/j.hrthm.2006.06.013
Robin, Jason ; Weinberg, Kenneth ; Tiongson, Jay ; Carnethon, Mercedes ; Reddy, Madhavi ; Ciaccio, Christina ; Quadrini, Michael ; Hsu, Jonathan ; Fan, John ; Choi, Patrick ; Kadish, Alan ; Goldberger, Jeffrey ; Passman, Rod. / Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. In: Heart Rhythm. 2006 ; Vol. 3, No. 10. pp. 1196-1201.
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abstract = "Background: Patients with end-stage renal disease are at increased risk for sudden cardiac death, although the utility of implantable cardioverter-defibrillators (ICDs) in these patients is unknown. Objectives: The purpose of this study was to evaluate whether end-stage renal disease is an independent risk factor for appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) and to compare the long-term survival of ICD recipients with and without end-stage renal disease. Methods: A retrospective cohort study was performed on ICD recipients at a single center. The primary endpoint was first appropriate ICD therapy for VT/VF. The secondary endpoint was survival. Results: The study included 585 patients, 19 (3.2{\%}) of whom had end-stage renal disease prior to device implantation. Average follow-up time was 2.2 ± 2.4 years, during which time 156 patients (26.7{\%}) received appropriate ICD therapy. End-stage renal disease was strongly associated with appropriate ICD therapy (hazard ratio 2.30, 95{\%} confidence interval 1.17-4.54) and remained a significant predictor following adjustment for implant indication, ejection fraction, diabetes, hypertension, and beta-blocker use. Survival was significantly shorter in the end-stage renal disease patients, with a median survival time of 3.2 ± 0.6 (SEM) years in the dialysis cohort and 7.4 ± 0.5 (SEM) years in those without end-stage renal disease (log rank P = .009). The majority of deaths in the end-stage renal disease cohort were due to non-device-related infection. Conclusion: In this cohort, end-stage renal disease was the single greatest predictor of ICD therapies for VT/VF. The survival rate was significantly shorter than that of ICD recipients without end-stage renal disease, suggesting that comorbidities in end-stage renal disease patients meeting current implant indications may reduce the survival benefit of ICD placement in this population.",
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AU - Robin, Jason

AU - Weinberg, Kenneth

AU - Tiongson, Jay

AU - Carnethon, Mercedes

AU - Reddy, Madhavi

AU - Ciaccio, Christina

AU - Quadrini, Michael

AU - Hsu, Jonathan

AU - Fan, John

AU - Choi, Patrick

AU - Kadish, Alan

AU - Goldberger, Jeffrey

AU - Passman, Rod

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Y1 - 2006/10/1

N2 - Background: Patients with end-stage renal disease are at increased risk for sudden cardiac death, although the utility of implantable cardioverter-defibrillators (ICDs) in these patients is unknown. Objectives: The purpose of this study was to evaluate whether end-stage renal disease is an independent risk factor for appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) and to compare the long-term survival of ICD recipients with and without end-stage renal disease. Methods: A retrospective cohort study was performed on ICD recipients at a single center. The primary endpoint was first appropriate ICD therapy for VT/VF. The secondary endpoint was survival. Results: The study included 585 patients, 19 (3.2%) of whom had end-stage renal disease prior to device implantation. Average follow-up time was 2.2 ± 2.4 years, during which time 156 patients (26.7%) received appropriate ICD therapy. End-stage renal disease was strongly associated with appropriate ICD therapy (hazard ratio 2.30, 95% confidence interval 1.17-4.54) and remained a significant predictor following adjustment for implant indication, ejection fraction, diabetes, hypertension, and beta-blocker use. Survival was significantly shorter in the end-stage renal disease patients, with a median survival time of 3.2 ± 0.6 (SEM) years in the dialysis cohort and 7.4 ± 0.5 (SEM) years in those without end-stage renal disease (log rank P = .009). The majority of deaths in the end-stage renal disease cohort were due to non-device-related infection. Conclusion: In this cohort, end-stage renal disease was the single greatest predictor of ICD therapies for VT/VF. The survival rate was significantly shorter than that of ICD recipients without end-stage renal disease, suggesting that comorbidities in end-stage renal disease patients meeting current implant indications may reduce the survival benefit of ICD placement in this population.

AB - Background: Patients with end-stage renal disease are at increased risk for sudden cardiac death, although the utility of implantable cardioverter-defibrillators (ICDs) in these patients is unknown. Objectives: The purpose of this study was to evaluate whether end-stage renal disease is an independent risk factor for appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) and to compare the long-term survival of ICD recipients with and without end-stage renal disease. Methods: A retrospective cohort study was performed on ICD recipients at a single center. The primary endpoint was first appropriate ICD therapy for VT/VF. The secondary endpoint was survival. Results: The study included 585 patients, 19 (3.2%) of whom had end-stage renal disease prior to device implantation. Average follow-up time was 2.2 ± 2.4 years, during which time 156 patients (26.7%) received appropriate ICD therapy. End-stage renal disease was strongly associated with appropriate ICD therapy (hazard ratio 2.30, 95% confidence interval 1.17-4.54) and remained a significant predictor following adjustment for implant indication, ejection fraction, diabetes, hypertension, and beta-blocker use. Survival was significantly shorter in the end-stage renal disease patients, with a median survival time of 3.2 ± 0.6 (SEM) years in the dialysis cohort and 7.4 ± 0.5 (SEM) years in those without end-stage renal disease (log rank P = .009). The majority of deaths in the end-stage renal disease cohort were due to non-device-related infection. Conclusion: In this cohort, end-stage renal disease was the single greatest predictor of ICD therapies for VT/VF. The survival rate was significantly shorter than that of ICD recipients without end-stage renal disease, suggesting that comorbidities in end-stage renal disease patients meeting current implant indications may reduce the survival benefit of ICD placement in this population.

KW - Dialysis

KW - End-stage renal disease

KW - Implantable cardioverter-defibrillator

KW - Sudden cardiac death

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