Mohammed Shurrab1,2,3,4, Dennis T Ko5,6,7, Yazan Zayed8, Sankar D Navaneethan9, Nour Yadak10, Abeer Yaseen10, Anna Kaoutskaia6, Waad Qamhia10, Zakaria Hamdan10, Saleem Haj-Yahia10,11, Douglas S Lee5,7,12, David Newman6, Jeff S Healey13, Paula Harvey14, Eugene Crystal6,14. 1. Cardiology Department, Health Sciences North, Sudbury, Ontario, Canada. shurrabm@hotmail.com. 2. Health Sciences North Research Institute, Sudbury, Ontario, Canada. shurrabm@hotmail.com. 3. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. shurrabm@hotmail.com. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. shurrabm@hotmail.com. 5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 6. Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 7. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 8. Department of Medicine, Hurley Medical Center, Flint, MI, USA. 9. Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 10. Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. 11. School of Clinical Sciences, University of Bristol, Bristol, UK. 12. Peter Munk Cardiac Centre and the Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada. 13. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 14. Division of Cardiology, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
PURPOSE: The efficacy of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in patients with chronic kidney disease (CKD) remains unclear. The aim of this meta-analysis is to explore the association between ICD/CRT and mortality in CKD patients. METHODS: An electronic search was conducted using MEDLINE. We included studies that reported outcomes of interest in CKD patients stratified by the presence of ICD, CRT, or none. The primary outcome was all-cause mortality. Outcomes were pooled using random effects model. Odds ratios (OR) were reported for dichotomous variables. RESULTS: The literature search resulted in 11 studies (observational studies) including 21,136 adult patients: seven studies compared ICD vs. no ICD and four studies compared CRT vs. ICD. All-cause mortality was significantly lower in the ICD group in comparison to that in the no ICD group (OR 0.66 (95% confidence interval [CI] 0.45; 0.98), P = 0.04). Among dialysis-only patients, all-cause mortality was significantly lower in the ICD group (OR 0.49 (95% CI 0.38; 0.64), P < 0.001). All-cause mortality was significantly lower in the CRT group in comparison to that in the ICD group (OR 0.73 (95% CI 0.57; 0.92), P = 0.01). CONCLUSIONS: The use of ICDs is associated with lower all-cause mortality in observational studies of CKD patients. CRT use was also associated with lower all-cause mortality in CKD patients in comparison to ICDs. A randomized controlled trial is required to definitively define the role of ICDs/CRTs in CKD patients.
PURPOSE: The efficacy of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in patients with chronic kidney disease (CKD) remains unclear. The aim of this meta-analysis is to explore the association between ICD/CRT and mortality in CKDpatients. METHODS: An electronic search was conducted using MEDLINE. We included studies that reported outcomes of interest in CKDpatients stratified by the presence of ICD, CRT, or none. The primary outcome was all-cause mortality. Outcomes were pooled using random effects model. Odds ratios (OR) were reported for dichotomous variables. RESULTS: The literature search resulted in 11 studies (observational studies) including 21,136 adult patients: seven studies compared ICD vs. no ICD and four studies compared CRT vs. ICD. All-cause mortality was significantly lower in the ICD group in comparison to that in the no ICD group (OR 0.66 (95% confidence interval [CI] 0.45; 0.98), P = 0.04). Among dialysis-only patients, all-cause mortality was significantly lower in the ICD group (OR 0.49 (95% CI 0.38; 0.64), P < 0.001). All-cause mortality was significantly lower in the CRT group in comparison to that in the ICD group (OR 0.73 (95% CI 0.57; 0.92), P = 0.01). CONCLUSIONS: The use of ICDs is associated with lower all-cause mortality in observational studies of CKDpatients. CRT use was also associated with lower all-cause mortality in CKDpatients in comparison to ICDs. A randomized controlled trial is required to definitively define the role of ICDs/CRTs in CKDpatients.
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