ICD Implantation Associated With Lower Risk of Mortality in Patients With CKD

Mortality in patients with chronic kidney disease (CKD) was improved with an implantable cardioverter defibrillator (ICD), according to a review published in The American Journal of Cardiology.

Cardiovascular disease is the leading cause of death in patients with CKD, which affects 14% of people in the United States. This meta-analysis aimed to investigate the relationship between ICD and all-cause mortality in patients with CKD.

The researchers conducted an electronic search of EBSCO CINAHL, Google Scholar, Ovid Embase, MEDLINE, and Web of Science. They also used the references of selected studies to search. Studies were included if they were retrospective or prospective and reported long-term mortality outcomes with a follow-up of 12 months or more; had patients with CKD, which was defined as having an estimated glomerular filtration rate of less than 60 mL/min/1.73 m² that persisted for at least 3 months; and were treated with an ICD with or without cardiac resynchronization therapy.

Fourteen studies were included in this review, consisting of 70,661 patients who had a mean follow up of 39 (range, 12-81) months, 70% of whom were men. Participants who had a mean (SD) age of 70 (4) years. All patients with ICD or resynchronization therapy were included. The studies also included patients who had ICD therapy.

ICD was associated with lower all-cause mortality (log HR, –0.247; SE, 0.101) compared with no ICD therapy in patients with CKD and with lower all-cause mortality in patients with CKD who did not have end-stage renal disease (log HR, –0.247; SE, 0.11) vs those who did not have ICD therapy.

ICD was associated with a trend toward lower all-cause mortality in patients with CKD who were on dialysis (log HR, –0.262; SE, 0.134) compared with patients without ICD, but this was not statistically significant and had significant heterogeneity, the study investigators noted.

There were some limitations to this review. Data on ICD use in patients with end-stage renal disease were limited, criteria for ICD implantation and follow-up periods varied widely across all the studies, and the results for patients on hemodialysis were heterogeneous and should be hypothesis generating.

The researchers concluded that all-cause mortality was associated with ICD implantation in patients with CKD, with the most dramatic results seen in patients with CKD who did not need dialysis.

Reference

Al-Sadawi M, Aslam F, Tao M, et al. Effect of implanted defibrillator on mortality in patients with chronic kidney disease. Am J Cardiol. 2023;188:36-40. doi:10.1016/j.amjcard.2022.11.011