Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients

Robin, Jason; Weinberg, Kenneth M.; Tiongson, Jay; Carnethon, Mercedes R.; Reddy, Madhavi; Ciaccio, Christina E.; Quadrini, Michael; Hsu, Jonathan C.; Fan, John S.; Choi, Patrick; Kadish, Alan H.; Goldberger, Jeffrey J.; Passman, Rod

doi:10.1016/j.hrthm.2006.06.013

Cited by 70 publications

(62 citation statements)

References 25 publications

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“…Clinically, patients on dialysis have a similar risk for cardiac arrest as patients who fulfill the criteria for prophylactic implantation of a cardioverter defibrillator (ICD) 12 ; however, multiple retrospective analyses have reported that ICDs would likely provide reduced survival benefits to patients on dialysis compared with the general population. [13][14][15] This is likely, because patients with ESRD have many comorbidities that compete for patient mortality. Taken all together, ICD implantation for the primary prevention of cardiac arrest in patients on dialysis may be effective but is currently unfeasible because of the high costs, limited reduction in absolute risk, and unproven efficacy.…”

Section: Discussionmentioning

confidence: 99%

Heritability of Risk for Sudden Cardiac Arrest in ESRD

Chan

Newton‐Cheh

Gusella

et al. 2015

Journal of the American Society of Nephrology

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Patients on dialysis are 20 times more likely to have a cardiac arrest compared with the general population. We considered whether inherited factors associate with cardiac arrest among patients on dialysis. From a sample of 647,457 patients on chronic dialysis, we identified 5117 pairs of patients who came from the same family. These patients were each matched to a control subject from the same population. McNemar's tests were used to compare the risk of cardiac arrest between the familial related and unrelated pairs. Genetically related family members who did not cohabitate had an odds ratio of 1.88 (95% confidence interval [95% CI], 1.25 to 2.84) for cardiac arrest compared with their phenotypically matched unrelated controls. Genetically related family members who lived together in the same environment had an odds ratio of 1.66 (95% CI, 1.20 to 2.28). Spouses, who are genetically unrelated but live together in the same environment, had an odds ratio of 0.95 (95% CI, 0.60 to 1.59) for cardiac arrest. The risk of cardiac arrest in patients on dialysis may be attributable to inherited factors. Additional studies are needed to identify such candidate genes that modify cardiovascular risk in ESRD.

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Section: Discussionmentioning

confidence: 99%

Heritability of Risk for Sudden Cardiac Arrest in ESRD

Chan

Newton‐Cheh

Gusella

et al. 2015

Journal of the American Society of Nephrology

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“…98 This group of ESRD patients was also more likely to receive appropriate therapies for ventricular fibrillation or ventricular tachycardia compared with their non-ESRD counterparts. [100][101][102] This discordance between appropriate ICD shocks and increased arrhythmic mortality suggests that patients with severe kidney dysfunction may be intermittently refractory to ICD therapies because of the unique metabolic derangements imparted by renal failure and dialytic treatment. 103,104 Defibrillation thresholds have also been reported to be higher in this group 101 and may increase the risk of ICD nonresponsiveness.…”

Section: Icdsmentioning

confidence: 99%

CKD and Sudden Cardiac Death

Whitman¹,

Feldman

Deo

2012

Journal of the American Society of Nephrology

118

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Multiple studies demonstrate a strong independent association between CKD and cardiovascular events including death, heart failure, and myocardial infarction. This review focuses on recent clinical studies that expand this spectrum of adverse cardiovascular events to include ventricular arrhythmias and sudden cardiac death. In addition, experimental models suggest structural remodeling of the heart and electrophysiologic changes in this population. These processes may explain the increased arrhythmic risk in kidney disease and aid in identifying patients who are at higher risk for sudden cardiac death. Finally, we review here the data to support the use of pharmacologic and device-based therapies for both the primary and secondary prevention of sudden cardiac death.

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“…This observation appears to be the case in special situations such as dialysis patients with low EF, in whom the risk of arrhythmic death is high but the mortality from competing risks is even greater, therefore leading to a situation in which interventions such as ICDs may have little or no impact or may actually reduce survival given the higher complication rates seen in this population. 31,32 Perhaps one of the most striking elements of all the risk stratification measures is found not in their positive predictive value but in their negative predictive value. Although this seems to be an appealing feature of a purported risk stratification technique, this observation is obviously due in large part to low event rates.…”

Section: Realities Of Risk Assessmentmentioning

confidence: 99%