Effect of Renal Function on Survival After Implantable Cardioverter Defibrillator Placement

Abstract

Implantable cardioverter defibrillators (ICDs) are effective at reducing arrhythmic death in patients with left ventricular dysfunction, but few studies have investigated the outcomes after ICD implantation in patients with chronic kidney disease (CKD). We conducted a 2-center retrospective study of 958 patients who had undergone ICD placement for primary prevention from the 2000 to 2006. The patients were stratified into 5 groups according to the CKD stage (stage 1, glomerular filtration [GFR] 90 to 120 ml/min; stage 2, GFR 60 to 89 ml/min; stage 3, GFR 30 to 59 ml/min; stage 4, GFR 15 to 29 ml/min; and stage 5, GFR 0 to 14 ml/min). The primary end point was death at 1 year. Of the 958 patients included in our analysis, 73 (7.6%) had died at 1 year. The mortality rate at 1 year increased with worsening CKD (1.8%, 5.3%, 9.0%, 22%, and 38% for stage 1 to 5, respectively, p <0.0001 for group). CKD was an independent predictor of mortality; hazard ratio 1.0, 1.075 (95% confidence interval 0.578 to 2.0), 1.372 (95% confidence interval 0.736 to 2.556), 3.092 (95% confidence interval 1.52 to 6.29), and 10.15 (95% confidence interval 4.25 to 24.23) for stage 1 to 5, respectively (p <0.0001 for group). Patients with CKD and left ventricular dysfunction have a poor prognosis despite ICD placement. The 1-year mortality increased as the renal function decreased. In conclusion, physicians should be cognizant of the prognosis when considering whether an ICD should be implanted in patients with CKD.