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Implantable cardioverter defibrillators in CKD increase risk for hospitalization

In patients with chronic kidney disease, the use of an implantable cardioverter defibrillator was associated with an increased risk of heart failure and any-cause hospitalizations but not all-cause mortality, according to research published in JAMA Internal Medicine.

“CKD is common in adults with heart failure and is associated with an increased risk of sudden cardiac death,” Nisha Bansal, MD, MAS, from the division of nephrology at the University of Washington, and colleagues wrote. “Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic death in selected patients with reduced left ventricular ejection fraction (LVEF) heart failure. However, whether ICDs improve clinical outcomes in patients with CKD is not well elucidated.”

Bansal and colleagues conducted a noninterventional cohort study to investigate how primary prevention ICDs affects the risk of all-cause mortality, heart failure hospitalizations and any-cause hospitalizations among community-based adults with CKD who had heart failure and an LVEF of 40% or less.

The researchers identified 5,877 eligible patients — 1,556 with an ICD and 4,321 without an ICD — from four Kaiser Permanente health care delivery systems (68.9% men; mean age, 72.9 years). Participants with an ICD were matched 1:3 to those without an ICD based on CKD status, age and high-dimensional propensity score for receipt of an ICD.

The analysis — adjusted for demographics, comorbidity and cardiovascular medication use —showed that all-cause mortality was similar between patients with CKD with an ICD and without an ICD (adjusted HR = 0.96; 95% CI, 0.87-1.06). However, patients with an ICD had a higher risk of subsequent hospitalizations due to heart failure (adjusted RR = 1.49; 95% CI, 1.33-1.60) and any-cause (aRR = 1.25; 95% CI, 1.20-1.30).

“The risks and benefits should be carefully balanced in the decision to place an ICD in patients with CKD and heart failure,” Bansal and colleagues concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.