TY - JOUR
T1 - Renal dysfunction and clinical outcomes of patients undergoing ICD and CRTD implantation
T2 - Data from the Israeli ICD registry
AU - Israeli working group of pacing and electrophysiology of the Israel Heart Society
AU - Eisen, Alon
AU - Suleiman, Mahmoud
AU - Strasberg, Boris
AU - Sela, Ron
AU - Rosenheck, Shimon
AU - Freedberg, Nahum A.
AU - Geist, Michael
AU - Ben-Zvi, Shlomit
AU - Goldenberg, Ilan
AU - Glikson, Michael
AU - Haim, Moti
PY - 2014/9
Y1 - 2014/9
N2 - Renal Function and Outcomes After Defibrillator Implantation. Background: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial.Objective: We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation.Methods: Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy.Results: During the study period (July 2010-November 2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR<30 mL/minute/1.73m2 (n=54, 4.6%)were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m2 was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5-19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1-7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ± 4.3 mL/minute/1.73 m2 in ICD patients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m2 in patients with CRTD (P = 0.2).Conclusion: Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.
AB - Renal Function and Outcomes After Defibrillator Implantation. Background: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial.Objective: We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation.Methods: Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy.Results: During the study period (July 2010-November 2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR<30 mL/minute/1.73m2 (n=54, 4.6%)were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m2 was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5-19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1-7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ± 4.3 mL/minute/1.73 m2 in ICD patients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m2 in patients with CRTD (P = 0.2).Conclusion: Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.
KW - Cardiac resynchronization therapy
KW - Chronic kidney disease
KW - Heart failure
KW - Implantable cardioverter defibrillator
KW - Renal insufficiency
UR - http://www.scopus.com/inward/record.url?scp=84908118693&partnerID=8YFLogxK
U2 - 10.1111/jce.12442
DO - 10.1111/jce.12442
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C2 - 24761993
AN - SCOPUS:84908118693
SN - 1045-3873
VL - 25
SP - 990
EP - 997
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 9
ER -
