University of Massachusetts Medical School Faculty Publications

Title

Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine

Publication Date

4-1-2017

Document Type

Article

Disciplines

Cardiology

Abstract

OBJECTIVE: Patients with chronic kidney disease (CKD) have higher risk of sudden cardiac death; however, they may not receive implantable cardioverter defibrillators (ICDs), in part due to higher risk of complications. We evaluated whether CKD is associated with greater risk of device-delivered shocks/antitachycardia pacing (ATP) therapies among patients receiving a primary prevention ICD.

METHODS: We studied participants in the observational Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter Defibrillators. CKD was defined as estimated glomerular filtration rate (eGFR) /min/1.73 m2. Outcomes included all delivered shocks/ATPs therapies and type of shock/ATP therapies (inappropriate or appropriate, determined by physician adjudication) within the 3 years. We evaluated the associations between CKD and time to first device therapy, burden of device therapy, and inappropriate versus appropriate device therapy, adjusting for demographics, comorbidity, laboratory values and medication use.

RESULTS: Among 2161 participants, 1066 (49.3%) had CKD (eGFR 44+/-11 mL/min/1.73 m2) at ICD implantation. During mean of 2.26+/-0.89 years, 9.8% and 18.5% of participants had at least one inappropriate and appropriate shock/ATP therapies, respectively. CKD was not associated with time to first shock/ATP therapies (adjusted HR 0.87, 95% CI 0.73 to 1.05), overall burden of shock/ATP therapies (adjusted relative rate 0.93, 95% CI 0.74 to 1.17) or inappropriate versus appropriate shock/ATP therapies (adjusted relative risk 0.88, 95% CI 0.68 to 1.14) compared with not having CKD.

CONCLUSIONS: In adults receiving a primary prevention ICD, mild-to-moderate CKD was not associated with the timing, burden or appropriateness of subsequent device therapy. Potential concern for inappropriate ICD-delivered therapies should not preclude ICDs among eligible patients with CKD.

Rights and Permissions

Citation: Heart. 2017 Apr;103(7):529-537. doi: 10.1136/heartjnl-2016-309842. Epub 2016 Oct 14. Link to article on publisher's site

Comments

Full author list omitted for brevity. For full list of authors see article.

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Heart (British Cardiac Society)

PubMed ID

27742796