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Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy.

Publication ,  Journal Article
Williams, ES; Shah, SH; Piccini, JP; Sun, AY; Koontz, JI; Al-Khatib, SM; Hranitzky, PM
Published in: Europace
December 2011

AIMS: Chronic kidney disease (CKD) is increasingly prevalent, and is an independent risk factor for cardiovascular mortality. Clinical trials of the implantable cardioverter-defibrillator (ICD) have demonstrated a survival benefit over medical therapy for the prevention of sudden cardiac death, but its benefit in patients with concomitant CKD is unclear. METHODS AND RESULTS: We studied 199 subjects with CKD, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), who underwent ICD implantation in the Duke Electrophysiology Genetic and Genomic Studies (EPGEN) biorepository. The mean age of the cohort was 67.8 ± 9.3 years, and the mean eGFR was 41.1 ± 13.2 mL/min/1.73 m(2). There were 63 deaths over a mean follow-up of 31.1 ± 18.8 months, corresponding to an annual mortality rate of 12.2%. Additionally, there was a 7% annual rate of appropriate ICD therapy. Using Cox regression analysis, older age, lower ejection fraction, and lower eGFR were found to be significant predictors of mortality. There was a gradient of risk associated with lower renal function: a 10 mL/min reduction in eGFR conferred a 48% increase in the risk of death (P < 0.001). Further adjustment for appropriate ICD therapy did not modify these associations. CONCLUSION: In patients with CKD treated with a defibrillator, more advanced renal dysfunction is associated with reduced survival despite appropriate defibrillator therapy. This may be due to competing mortality risks in this population that attenuate the benefit of the ICD in reducing arrhythmic death. Age, ejection fraction, and kidney disease severity can be used to risk stratify patients before device implantation.

Duke Scholars

Published In

Europace

DOI

EISSN

1532-2092

Publication Date

December 2011

Volume

13

Issue

12

Start / End Page

1717 / 1722

Location

England

Related Subject Headings

  • Survival Rate
  • Stroke Volume
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Kidney Diseases
  • Kaplan-Meier Estimate
 

Citation

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Williams, E. S., Shah, S. H., Piccini, J. P., Sun, A. Y., Koontz, J. I., Al-Khatib, S. M., & Hranitzky, P. M. (2011). Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy. Europace, 13(12), 1717–1722. https://doi.org/10.1093/europace/eur253
Williams, Eric S., Svati H. Shah, Jonathan P. Piccini, Albert Y. Sun, Jason I. Koontz, Sana M. Al-Khatib, and Patrick M. Hranitzky. “Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy.Europace 13, no. 12 (December 2011): 1717–22. https://doi.org/10.1093/europace/eur253.
Williams ES, Shah SH, Piccini JP, Sun AY, Koontz JI, Al-Khatib SM, et al. Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy. Europace. 2011 Dec;13(12):1717–22.
Williams, Eric S., et al. “Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy.Europace, vol. 13, no. 12, Dec. 2011, pp. 1717–22. Pubmed, doi:10.1093/europace/eur253.
Williams ES, Shah SH, Piccini JP, Sun AY, Koontz JI, Al-Khatib SM, Hranitzky PM. Predictors of mortality in patients with chronic kidney disease and an implantable defibrillator: an EPGEN substudy. Europace. 2011 Dec;13(12):1717–1722.
Journal cover image

Published In

Europace

DOI

EISSN

1532-2092

Publication Date

December 2011

Volume

13

Issue

12

Start / End Page

1717 / 1722

Location

England

Related Subject Headings

  • Survival Rate
  • Stroke Volume
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Kidney Diseases
  • Kaplan-Meier Estimate