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Renal Dysfunction and Clinical Outcomes of Patients Undergoing ICD and CRTD Implantation: Data from the Israeli ICD Registry
Author(s) -
EISEN ALON,
SULEIMAN MAHMOUD,
STRASBERG BORIS,
SELA RON,
ROSENHECK SHIMON,
FREEDBERG NAHUM A.,
GEIST MICHAEL,
BENZVI SHLOMIT,
GOLDENBERG ILAN,
GLIKSON MICHAEL,
HAIM MOTI
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12442
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , heart failure , renal function , kidney disease , ventricular assist device , diabetes mellitus , atrial fibrillation , implantable cardioverter defibrillator , ventricular tachycardia , ejection fraction , endocrinology
Renal Function and Outcomes After Defibrillator Implantation Background Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial. Objective We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation. Methods Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all‐cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy. Results During the study period (July 2010–November 2012), 2,811 patients were implanted with ICD or CRTD. One‐year follow‐up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR < 30 mL/minute/1.73 m 2 (n = 54, 4.6%) were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m 2 was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5–19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1–7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow‐up decreased by 8.0 ± 4.3 mL/minute/1.73 m 2 in ICD patients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m 2 in patients with CRTD (P = 0.2). Conclusion Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.