Abstract
Importance
Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. 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.Objective
To examine the association of primary prevention ICDs with risk of death and hospitalization in a community-based population of potentially ICD-eligible patients who had heart failure with reduced LVEF and CKD.Design, settings, and participants
This noninterventional cohort study included adults with heart failure and an LVEF of 40% or less and measures of serum creatinine levels available from January 1, 2005, through December 31, 2012, who were enrolled in 4 Kaiser Permanente health care delivery systems. Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2. Patients who received and did not receive an ICD were matched (1:3) on CKD status, age, and high-dimensional propensity score to receive an ICD. Follow-up was completed on December 31, 2013. Data were analyzed from 2015 to 2017.Exposures
Placement of an ICD.Main outcomes and measures
All-cause death, hospitalizations due to heart failure, and any-cause hospitalizations.Results
A total of 5877 matched eligible adults with CKD (1556 with an ICD and 4321 without an ICD) were identified (4049 men [68.9%] and 1828 women [31.1%]; mean [SD] age, 72.9 [8.2] years). In models adjusted for demographics, comorbidity, and cardiovascular medication use, no difference was found in all-cause mortality between patients with CKD in the ICD vs non-ICD groups (adjusted hazard ratio, 0.96; 95% CI, 0.87-1.06). However, ICD placement was associated with increased risk of subsequent hospitalization due to heart failure (adjusted relative risk, 1.49; 95% CI, 1.33-1.60) and any-cause hospitalization (adjusted relative risk, 1.25; 95% CI, 1.20-1.30) among patients with CKD.Conclusions and relevance
In a large, contemporary, noninterventional study of community-based patients with heart failure and CKD, ICD placement was not significantly associated with improved survival but was associated with increased risk for subsequent hospitalization due to heart failure and all-cause hospitalization. The potential risks and benefits of ICDs should be carefully considered in patients with heart failure and CKD.Free full text
Full text links
Read article at publisher's site: https://doi.org/10.1001/jamainternmed.2017.8462
Read article for free, from open access legal sources, via Unpaywall: https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2671406/jamainternal_bansal_2018_oi_170130.pdf
Citations & impact
Impact metrics
Article citations
Cardiac Device Therapy in Patients with Chronic Kidney Disease: An Update.
J Clin Med, 13(2):516, 17 Jan 2024
Cited by: 0 articles | PMID: 38256650 | PMCID: PMC10816721
Review Free full text in Europe PMC
Emerging Preventive Strategies in Chronic Kidney Disease: Recent Evidence and Gaps in Knowledge.
Curr Atheroscler Rep, 25(12):1047-1058, 01 Dec 2023
Cited by: 0 articles | PMID: 38038822
Review
Elevated serum albumin-to-creatinine ratio as a protective factor on outcomes after heart transplantation.
Front Cardiovasc Med, 10:1210278, 07 Sep 2023
Cited by: 0 articles | PMID: 37745114 | PMCID: PMC10512951
Can the Norton Scale Score Be Used as an Adjunct Tool for Implantable Defibrillator Patient Selection? A Retrospective Single-Center Cohort Study.
J Clin Med, 12(1):214, 27 Dec 2022
Cited by: 0 articles | PMID: 36615015 | PMCID: PMC9821316
Quality of observational studies of clinical interventions: a meta-epidemiological review.
BMC Med Res Methodol, 22(1):313, 07 Dec 2022
Cited by: 0 articles | PMID: 36476329 | PMCID: PMC9727931
Go to all (17) article citations
Similar Articles
To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Implantable cardioverter-defibrillators in patients with CKD: a propensity-matched mortality analysis.
Clin J Am Soc Nephrol, 10(7):1119-1127, 25 Jun 2015
Cited by: 16 articles | PMID: 26111859 | PMCID: PMC4491299
Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators.
Heart, 103(7):529-537, 14 Oct 2016
Cited by: 2 articles | PMID: 27742796 | PMCID: PMC5558610
Estimated Glomerular Filtration Rate and Implantable Cardioverter-Defibrillator in Nonischemic Systolic Heart Failure: Extended Follow-Up of DANISH.
J Am Heart Assoc, 13(3):e031977, 31 Jan 2024
Cited by: 0 articles | PMID: 38293926
Do implantable cardioverter defibrillators improve survival in patients with chronic kidney disease at high risk of sudden cardiac death? A meta-analysis of observational studies.
Europace, 16(1):55-62, 20 Sep 2013
Cited by: 17 articles | PMID: 24058182
Review
A review of the evidence on the effects and costs of implantable cardioverter defibrillator therapy in different patient groups, and modelling of cost-effectiveness and cost-utility for these groups in a UK context.
Health Technol Assess, 10(27):iii-iv, ix-xi, 1-164, 01 Jan 2006
Cited by: 28 articles | PMID: 16904046
ReviewBooks & documents Free full text in Europe PMC