Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators
Recommended Citation
Bansal N, Szpiro A, Masoudi F, Greenlee RT, Smith DH, Magid DJ, Gurwitz JH, Reynolds K, Tabada GH, Sung SH, Dighe A, Cassidy-Bushrow A, Garcia-Montilla R, Hammill S, Hayes J, Kadish A, Sharma P, Varosy P, Vidaillet H, and Go AS. Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators. Heart 2016;103(7):529-537.
Document Type
Article
Publication Date
4-1-2017
Publication Title
Heart
Abstract
Objective: Patients with chronic kidney disease (CKD) have higher risk of sudden cardiac death; however, they may not receive implantable cardioverter defibrillators (ICDs), in part due to higher risk of complications. We evaluated whether CKD is associated with greater risk of device-delivered shocks/antitachycardia pacing (ATP) therapies among patients receiving a primary prevention ICD.
Methods: We studied participants in the observational Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter Defibrillators. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Outcomes included all delivered shocks/ATPs therapies and type of shock/ATP therapies (inappropriate or appropriate, determined by physician adjudication) within the 3 years. We evaluated the associations between CKD and time to first device therapy, burden of device therapy, and inappropriate versus appropriate device therapy, adjusting for demographics, comorbidity, laboratory values and medication use.
Results: Among 2161 participants, 1066 (49.3%) had CKD (eGFR 44±11 mL/min/1.73 m2) at ICD implantation. During mean of 2.26±0.89 years, 9.8% and 18.5% of participants had at least one inappropriate and appropriate shock/ATP therapies, respectively. CKD was not associated with time to first shock/ATP therapies (adjusted HR 0.87, 95% CI 0.73 to 1.05), overall burden of shock/ATP therapies (adjusted relative rate 0.93, 95% CI 0.74 to 1.17) or inappropriate versus appropriate shock/ATP therapies (adjusted relative risk 0.88, 95% CI 0.68 to 1.14) compared with not having CKD.
Conclusions: In adults receiving a primary prevention ICD, mild-to-moderate CKD was not associated with the timing, burden or appropriateness of subsequent device therapy. Potential concern for inappropriate ICD-delivered therapies should not preclude ICDs among eligible patients with CKD.
Medical Subject Headings
Aged; Aged, 80 and over; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Glomerular Filtration Rate; Heart Failure; Humans; Kidney; Longitudinal Studies; Male; Middle Aged; Primary Prevention; Prosthesis Design; Prosthesis Failure; Renal Insufficiency, Chronic; Risk Factors; Stroke Volume; Time Factors; Treatment Outcome; United States; Ventricular Function, Left
PubMed ID
27742796
Volume
103
Issue
7
First Page
529
Last Page
537
