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Prevention of sudden cardiac death (SCD) is an important target for improving survival in various patient groups and many prevention options have been evaluated. In the past decade several trials have documented beneficial effects for implantable cardioverter-defibrillator (ICD) implantation in patients surviving out-of-hospital cardiac arrest (secondary prevention) and in patients with diminished left ventricular function (primary prevention).1 However, within these patient groups a variety of comorbidities is present which might influence the benefit conferred by prophylactic ICD implantation. One of these comorbidities is chronic kidney disease (CKD), a condition that is highly prevalent among patients with a current ICD indication. CKD is of particular interest since this condition is associated with a substantial risk for non-arrhythmic death and this might negatively influence the beneficial effects of prophylactic ICD implantation. Accordingly this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness.
Mechanisms of SCD in CKD
The mechanisms that underlie SCD in patients with CKD are complex and many factors have been associated with increasing the risk for SCD. Beside coronary artery disease (CAD), present in 80% of the patients dying from SCD, many other factors are believed to contribute to the development of SCD in patients with CKD which also might form therapeutic targets for preventing SCD in these patients. The key factors in the development of SCD, including CAD, will be discussed below and are summarised in table 1.
Ischaemic heart disease
CAD is highly prevalent among patients with CKD and is more severe compared to …
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