Abstract 10115: Decreased Renal Function Associated With More Appropriate ICD Shocks and a Higher Mortality
Introduction: Patients with chronic kidney disease represent a special group within ICD recipients. Sudden Cardiac Death (SCD) is an important cause of death in these patients, but they also suffer from a higher risk of ICD related complications. We investigated the relationship between renal function and appropriate ICD therapy and mortality in a large single center cohort of ICD recipients.
Methods: All ICD and CRT-D recipients in our center since 1996 were analyzed. Patients were categorized into 4 groups based on estimated glomerular filtration rate (eGFR). An eGFR>90 mL/min/1.73m2 was defined as normal. We categorized cause of death as cardiac, sudden, noncardiac or unknown death. Kaplan Meier analysis was used to compare mortality.
Results: We included 3276 patients. During follow-up 871 (27%) patients died (median time to death 3.1 years iqr. 1.2-5.6). Survival was worse with a lower GFR (p<0.001, fig). Patients with GFR<90 received appropriate therapy sooner after ICD implant when compared to patients with normal renal function (2.1±0.1 vs. 2.5±0,1yrs p=0.02). Patients with a GFR>90 died most frequently from a non-cardiac cause (39%) whereas patients with a lower GFR died more often from a cardiac cause (44%). Heart failure was the most common cause of death in all patients (34%). SCD occurred in 1% of patients.
Conclusion: Patients with kidney dysfunction receive appropriate ICD therapy sooner after device implantation then patients with normal kidney function. Furthermore, survival in these patients is significantly lower, despite their device. A trial analyzing the benefit of ICD therapy in in patients with kidney dysfunction is badly needed.
- © 2013 by American Heart Association, Inc.