Risk of death without appropriate defibrillator shock in patients with advanced renal dysfunction

Ido Goldenberg, Tal Mor, Eyal Nof, Arwa Younis, Anat Berkovitch, Raphael Rosso, Alon Barsheshet, Mahmoud Suleiman, Roy Beinart*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Heart failure patients with advanced chronic kidney disease (CKD) may experience an increased rate of non-arrhythmic mortality due to associated comorbidities. We aimed to evaluate the risk of mortality without appropriate implantable cardioverter-defibrillator (ICD) shocks in this high-risk population. Methods and results The study population comprised 3542 patients who received an ICD, were enrolled, and prospectively followed-up in the Israeli ICD registry. Study patients were categorized into two groups: those with advanced CKD [defined by a glomerular filtration rate of <30 mL/min/1.73 m 2 or being on dialysis at time of implantation (n = 197)], and those without advanced CKD (n = 3344). The primary endpoint was the risk of death without receiving appropriate ICD shock. Kaplan-Meier survival analysis showed that at 5 years of follow-up the rates of death without prior ICD shock were significantly higher in the advanced kidney disease group (46%) compared with the non-advanced CKD group (19%; log-rank P-value <0.001). Consistently, multivariate analysis showed that the risk of death without receiving appropriate ICD shock therapy at 5 years was 2.5-fold (P < 0.001) higher among advanced CKD patients. In contrast, the rate of appropriate ICD shock therapy at 5 years among advanced CKD patients was only 9%, with a very high mortality rate (63%) within 3.5 years subsequent to shock therapy. Conclusion Nearly one-half of ICD with advanced CKD die within 5 years without receiving an appropriate ICD shock. These findings stress the importance of appropriate patient selection for primary ICD implantation in this high-risk population.

Original languageEnglish
Pages (from-to)459-464
Number of pages6
JournalEuropace
Volume21
Issue number3
DOIs
StatePublished - 1 Mar 2019
Externally publishedYes

Keywords

  • Appropriate shock
  • Chronic kidney disease
  • Implantable cardioverter-defibrillator

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