Abstract 13732: Implantable Cardioverter Defibrillators Reduce Mortality in Patients with Chronic Kidney Disease: A Meta-Analysis
Background---Current guidelines recommend a primary prevention implantable cardioverter defibrillator (ICD) in NYHA class II or III heart failure patients with an ejection fraction of ≤35%. However, those clinical trials that form the basis of the current guidelines, largely exclude patients with chronic kidney disease (CKD) (defined as kidney damage or estimated glomerular filtration rate eGFR <60ml/min/1.73 m2 for at least 3 months). Studies addressing the mortality benefits of ICD in CKD patients have so far been inconclusive.
Objective---To evaluate the effects of ICD on all-cause mortality in CKD patients based on current data
Methods---We performed two separate meta-analyses to assess all-cause mortality between: 1) ICD patients with and without CKD and 2) CKD patients (meeting primary or secondary prevention criteria for ICD) with and without ICDs. Medline and Embase were searched from 1966 - 2011. A manual search by cross-referencing was also performed. Meta-analysis of sixteen observational studies with 4831 patients showed that CKD was associated with higher mortality risk (HR = 2.336,95%CI = 1.714-3.185, p<0.05) in patients with ICDs after adjusting for confounders using multivariate regression analysis. Significant heterogeneity was noted among studies using the Q test(p <0.001). Three observational studies with 7365 CKD patients showed a significant survival benefit from the ICD in CKD patients (adjusted HR=0.599, 95% CI = 0.413-0.868, p<0.05).
Conclusion---This meta-analysis indicates that for patients who receive ICDs, CKD is associated with increased mortality. Nevertheless, ICDs may offer survival benefit even for the subgroup who has CKD.
- © 2012 by American Heart Association, Inc.