Abstract 13668: Implantable Cardioverter Defibrillator Therapy for Primary Prevention of Sudden Cardiac Death is Effective in Patients with Chronic Kidney Disease
Introduction: Efficacy of implantable cardioverter defibrillator (ICD) therapy for primary prevention of sudden cardiac death (SCD) is unclear in patients (pts) with advanced chronic kidney disease (CKD). We hypothesized that benefit from ICD therapy is similar in pts with vs. without CKD.
Methods: We included 556 consecutive pts who underwent new ICD implantation or generator replacement for primary prevention of sudden cardiac death at the Minneapolis VA Medical Center from 2006 to 2010. Estimated glomerular filtration rate (eGFR) was calculated by MDRD formula. Pts with stage III (eGFR 30-60 mL/min/1.73m2) and stage IV or V CKD (eGFR<29 mL/min/1.73m2 or on dialysis) were identified. Follow-up was uniform and ICD shocks were adjudicated as “appropriate” or “inappropriate”.
Results: Mean age of the pts was 68±10 and 99% were male. Of the 556 pts, 230 (41%) had stage III CKD and 25 (5%) had stage IV or V CKD. CKD pts were older, had higher NYHA class and were more likely to have other comorbidities compared to pts without CKD (Table). However, ejection fraction was similar in the 3 groups. After 3.3±2.4 years of follow-up, the incidence of appropriate (p=0.95) and inappropriate (p=0.62) ICD shocks did not differ significantly in the 3 groups (Table). All-cause mortality was higher in pts with CKD (p<0.0001) (Table). However, time from first appropriate ICD shock to death (or ICD shock to last follow-up, if the pt was alive), used as a surrogate of survival benefit from ICD, was similar in pts with or without CKD (p=0.36) (Table).
Conclusions: Efficacy of ICD therapy for primary prevention of SCD is similar in patients with versus without CKD. Consequently, CKD patients are appropriate candidates for primary prevention ICD therapy.
- © 2012 by American Heart Association, Inc.