The Relationship Between Glomerular Filtration Rate and Survival in Patients Treated with an Implantable Cardioverter Defibrillator

Abstract

Objectives: We explored the association between renal insufficiency (RI) and mortality among patients treated with an implantable cardioverter defibrillator (ICD). Background: Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiency patients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients. Methods: This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m 2 ) at implantation: group I, > 75.0; group II, −60.0 to 74.9; group III, −45.0 to 59.9; and group IV, − ≤45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves.Results: Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I −6.8%, II −13.8%, III −11.5%, IV −45.8% (p<0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes.

Influence of Renal Function on Mortality and Ventricular Arrhythmias in Patients Undergoing First Implantable Cardioverter‐Defibrillator Generator Replacement

“…Patients with advanced chronic renal failure on dialysis are known to be at increased risk for sudden cardiac arrest, but the mechanisms underlying this association are not well defined . The association between renal function at the time of initial ICD implantation and subsequent mortality has been previously explored, and most data have suggested an independent association between impaired renal function at the time of initial ICD implantation and subsequent increased mortality , . A meta‐analysis of the MADIT‐I, MADIT‐II, and SCD‐HeFT randomized control trials also demonstrated that patients with a CKD‐EPI eGFR <60 mL/min/1.73 m 2 derived no net mortality benefit from primary prevention ICD implantation …”

“…28 The association between renal function at the time of initial ICD implantation and subsequent mortality has been previously explored, and most data have suggested an independent association between impaired renal function at the time of initial ICD implantation and subsequent increased mortality. 8,[13][14][15][16][17][18][19][20] A meta-analysis of the MADIT-I, MADIT-II, and SCD-HeFT randomized control trials also demonstrated that patients with a CKD-EPI eGFR <60 mL/min/1.73 m 2 derived no net mortality benefit from primary prevention ICD implantation. 29 The association between renal function at the time of ICD generator replacement and mortality is less well studied.…”

“…11 Impaired renal function at the time of initial ICD implantation has been shown to predict increased procedural complications 12 and increased mortality. 8,[13][14][15][16][17][18][19][20] Small studies that have evaluated the association between renal function and appropriate ICD therapies after initial ICD implantation have also suggested that impaired renal function is independently associated with a higher incidence of ventricular arrhythmias requiring ICD therapy, [21][22][23][24][25] although not all reports have confirmed this relationship. 26 The correlations between renal function, mortality, and appropriate ICD therapies after ICD generator replacement are not well defined.…”