Paul L Hess1, Anne S Hellkamp2, Eric D Peterson2, Gillian D Sanders2, Hussein R Al-Khalidi2, Lesley H Curtis2, Bradley G Hammill2, Patrick H Pun2, Jeptha P Curtis2, Kevin J Anstrom2, Stephen C Hammill2, Sana M Al-Khatib2. 1. From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.). p.hess@duke.edu. 2. From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
Abstract
BACKGROUND: Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD). METHODS AND RESULTS: Using the National Cardiovascular Data Registry ICD registry linked with the Social Security Death Master File, we assessed the rate of death after primary prevention ICD placement between January 1, 2006, and December 31, 2007, according to CKD stage. Using Cox models, we identified factors associated with death among patients with CKD. Compared with patients without CKD (n=26,056), those with CKD (n=21,226) were older, less commonly men, more often white, and more frequently had comorbid illness. Compared with patients without CKD, patients with a glomerular filtration rate 30 to 60, glomerular filtration rate <30, and end-stage renal disease on dialysis had a higher risk of death after ICD placement (hazard ratio, 2.08; 95% confidence interval, 1.99-2.18; P<0.0001; hazard ratio, 4.20; 95% confidence interval, 3.92-4.50; P<0.0001; and hazard ratio, 4.80; 95% confidence interval, 4.46-5.17; P<0.0001, respectively). Corresponding 1-year death rates were 4.4%, 9.1%, 20.2%, and 22.4%. Among patients with CKD, factors associated with increased risk of death included CKD severity, age >65 years, heart failure symptoms, diabetes mellitus, lung disease, serum sodium <140 mEq/L, atrial fibrillation or flutter, and a lower ejection fraction. CONCLUSIONS: The risk of death after primary prevention ICD placement is proportional to CKD severity. Among patients with CKD, several factors are prognostically significant and could inform clinical decision making on primary prevention ICD candidacy.
BACKGROUND: Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD). METHODS AND RESULTS: Using the National Cardiovascular Data Registry ICD registry linked with the Social Security Death Master File, we assessed the rate of death after primary prevention ICD placement between January 1, 2006, and December 31, 2007, according to CKD stage. Using Cox models, we identified factors associated with death among patients with CKD. Compared with patients without CKD (n=26,056), those with CKD (n=21,226) were older, less commonly men, more often white, and more frequently had comorbid illness. Compared with patients without CKD, patients with a glomerular filtration rate 30 to 60, glomerular filtration rate <30, and end-stage renal disease on dialysis had a higher risk of death after ICD placement (hazard ratio, 2.08; 95% confidence interval, 1.99-2.18; P<0.0001; hazard ratio, 4.20; 95% confidence interval, 3.92-4.50; P<0.0001; and hazard ratio, 4.80; 95% confidence interval, 4.46-5.17; P<0.0001, respectively). Corresponding 1-year death rates were 4.4%, 9.1%, 20.2%, and 22.4%. Among patients with CKD, factors associated with increased risk of death included CKD severity, age >65 years, heart failure symptoms, diabetes mellitus, lung disease, serum sodium <140 mEq/L, atrial fibrillation or flutter, and a lower ejection fraction. CONCLUSIONS: The risk of death after primary prevention ICD placement is proportional to CKD severity. Among patients with CKD, several factors are prognostically significant and could inform clinical decision making on primary prevention ICD candidacy.
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Ilan Goldenberg; Arthur J Moss; Scott McNitt; Wojciech Zareba; Mark L Andrews; W Jackson Hall; Henry Greenberg; Robert B Case Journal: Am J Cardiol Date: 2006-06-19 Impact factor: 2.778
Authors: Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; Douglas L Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; George Johnson; Steven E McNulty; Nancy Clapp-Channing; Linda D Davidson-Ray; Elizabeth S Fraulo; Daniel P Fishbein; Richard M Luceri; John H Ip Journal: N Engl J Med Date: 2005-01-20 Impact factor: 91.245
Authors: Phillip S Cuculich; José Mauricio Sánchez; Roger Kerzner; Scott L Greenberg; Jay Sengupta; Jane Chen; Mitchell N Faddis; Marye J Gleva; Timothy W Smith; Bruce D Lindsay Journal: Pacing Clin Electrophysiol Date: 2007-02 Impact factor: 1.976
Authors: Patrick H Pun; Sana M Al-Khatib; Joo Yoon Han; Rex Edwards; Gust H Bardy; J Thomas Bigger; Alfred E Buxton; Arthur J Moss; Kerry L Lee; Richard Steinman; Paul Dorian; Al Hallstrom; Riccardo Cappato; Alan H Kadish; Peter J Kudenchuk; Daniel B Mark; Paul L Hess; Lurdes Y T Inoue; Gillian D Sanders Journal: Am J Kidney Dis Date: 2014-02-08 Impact factor: 8.860
Authors: Patrick H Pun; Shubin Sheng; Gillian Sanders; Adam D DeVore; Daniel Friedman; Gregg C Fonarow; Paul A Heidenreich; Clyde W Yancy; Adrian F Hernandez; Sana M Al-Khatib Journal: Am J Cardiol Date: 2016-12-18 Impact factor: 2.778
Authors: Georges N Nakhoul; Jesse D Schold; Susana Arrigain; Serge C Harb; Stacey Jolly; Bruce L Wilkoff; Joseph V Nally; Sankar D Navaneethan Journal: Clin J Am Soc Nephrol Date: 2015-06-25 Impact factor: 8.237
Authors: Ashok Krishnaswami; Mary-Lou Kiley; Faith F Anthony; Yuexin Chen; Jason Chen; Sumanth Rajagopal; Taylor I Liu; Charlie Young; Elizabeth W Paxton Journal: Perm J Date: 2015-11-02
Authors: Giuseppe Boriani; Irina Savelieva; Gheorghe-Andrei Dan; Jean Claude Deharo; Charles Ferro; Carsten W Israel; Deirdre A Lane; Gaetano La Manna; Joseph Morton; Angel Moya Mitjans; Marc A Vos; Mintu P Turakhia; Gregory Y H Lip Journal: Europace Date: 2015-06-24 Impact factor: 5.214
Authors: Rajat Deo; Yulia A Khodneva; Michael G Shlipak; Elsayed Z Soliman; Suzanne E Judd; William M McClellan; Todd M Brown; J David Rhodes; Orlando M Gutiérrez; Sanjiv J Shah; Christine M Albert; Monika M Safford Journal: Heart Rhythm Date: 2016-08-11 Impact factor: 6.343