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ICDs, CRT linked to improved survival in chronic kidney disease
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CHICAGO — Implantable cardioverter defibrillators and cardiac resynchronization therapy may be associated with increased survival in patients with chronic kidney disease, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.
“[Chronic kidney disease] is associated with increased CV mortality, particularly from sudden cardiac death, with the highest risk in dialysis patients,” David Newman, MD, from the Sunnybrook Health Sciences Centre in Toronto, said during a presentation of data from a recent meta-analysis. “ICDs and CRT have a valuable role in primary and secondary prevention of sudden cardiac death, but most trials that study ICDs generally exclude or do not adequately demonstrate or discuss the approach in the trial for those with advanced [chronic kidney disease].”
To fill this knowledge gap, Newman and colleagues conducted a meta-analysis of studies that reported outcomes in patients with chronic kidney disease (CKD) stratified by the presence of ICDs, CRT or none. The primary outcome was all-cause mortality.
Ten retrospective and one prospective nonrandomized studies involving 20,920 adults were included in the analysis. Of these patients, 3,568 had ICDs and 10,838 had CRT. Baseline characteristics were comparable between groups, and follow-up ranged from 1 to 4 years.
Among patients with ICDs, more than half had coronary disease, ejection fraction was low, and beta-blocker and statin use was high. The researchers also noted a mix of timelines and indications for ICDs. Results showed that all-cause mortality was lower among patients with ICDs vs. those without ICDs or CRT (51% vs. 66%; OR = 0.48; 95% CI, 0.42-0.55), according to the data.
Among patients with CRT, the researchers also found a mixture of primary and secondary prevention indications and more modern timelines, Newman reported. More patients had coronary disease than in the ICD group and rates of beta-blocker use remained high. All-cause mortality was also lower among patients with CRT vs. those with ICDs (37% vs. 42%; OR = 1.38; 95% CI, 1.08-1.76), with no significant heterogeneity noted for comparisons.
“Our results suggest that there is a protective effect of ICDs or CRT in CKD patients, with an improved overall survival despite the compelling comorbidities that are involved,” Newman said. “Furthermore, we’re suggesting that CKD patients are prone to ventricular arrhythmias terminated with ICD therapy. However, severe CKD patients may perhaps be too sick to benefit from ICDs, given the competing causes of death that ICD itself may not mitigate.”
Newman also noted that CRT demonstrates an even greater survival benefit than ICDs in patients with CKD, although the reasons for this advantage remains unknown.
“A randomized controlled trial may be reasonable to consider so we can define the true role of cardiac implantable electronic device therapy in CKD patients,” he said. – by Melissa Foster
Reference:
Shurrab M, et al. Abstract AB24-04. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 10-13, 2017; Chicago.
Disclosure: The researchers report no relevant financial disclosures.