Poor Prognosis for Patients with Chronic Kidney Disease Despite ICD Therapy for the Primary Prevention of Sudden Death

Abstract

In patients receiving an ICD for primary prevention of sudden death, CKD significantly reduced long-term survival. This poor prognosis may limit the impact of primary prevention ICD therapy in this patient population.

Refining Patient Selection for Primary Prevention Implantable Cardioverter-Defibrillator Therapy

“…Investigators have reported that patients with advanced age and chronic renal failure do not benefit from primary prevention ICDs because of imminent, competing causes of death. [12][13][14] Both the risk-benefit and cost-benefit ratios of primary prevention ICD therapy would be improved by strategies to exclude presently indicated patients who are unlikely to benefit, if they could be identified accurately.…”

Primary prevention with the ICD in clinical practice: not as straightforward as the guidelines suggest?

“…16 In a retrospective study of 35 patients with chronic kidney disease, out of 229 who had an ICD implanted for primary prevention, Cuculich et al registered a one-year survival of 61.8% in patients with a serum creatinine of >177 µmol/l or on chronic dialysis, compared with 96.3% in controls. 17 This lack of benefit in the more diseased population was also apparent in the SCDHeFT trial: whereas in NYHA class II patients there was a 46% reduction in risk of death, patients in NYHA class III had no advantage with an ICD compared with placebo.…”

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

“…An increasing number of noncardiac comorbidities has the potential to blunt or negate the benefit of ICD therapy due to competing risks for death [52]. The potential futility of ICD efficacy in patients with chronic and end-stage renal disease has been suggested by multiple retrospective cohort analyses [70][71][72][73]. The Charlson comorbidity index (CCI) is widely used as an adjustment variable in prognostic models [74].…”