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Arrhythmias and sudden death
Original article
Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators
  1. Nisha Bansal1,
  2. Adam Szpiro2,
  3. Frederick Masoudi3,
  4. Robert T Greenlee4,
  5. David H Smith5,
  6. David J Magid6,
  7. Jerry H Gurwitz7,
  8. Kristi Reynolds8,
  9. Grace H Tabada9,
  10. Sue Hee Sung9,
  11. Ashveena Dighe1,
  12. Andrea Cassidy-Bushrow10,
  13. Romel Garcia-Montilla4,
  14. Stephen Hammill11,
  15. John Hayes4,
  16. Alan Kadish12,
  17. Param Sharma4,
  18. Paul Varosy3,
  19. Humberto Vidaillet4,
  20. Alan S Go9
  1. 1Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
  2. 2Department of Biostatistics, University of Washington, Seattle, Washington, USA
  3. 3University of Colorado Hospital, Aurora, Colorado, USA
  4. 4Marshfield Clinic Research Foundation, Wisconsin, USA
  5. 5Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
  6. 6Kaiser Permanente Colorado Institute for Health Research, Oakland, California, USA
  7. 7Meyers Primary Care Institute, Worcester, Massachusetts, USA
  8. 8Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
  9. 9Kaiser Permanente Northern California Division of Research, Oakland, California, USA
  10. 10Henry Ford Hospital, Detroit, Michigan, USA
  11. 11Mayo Clinic, Rochester, Minnesota, USA
  12. 12Touro College, New York, USA
  1. Correspondence to Dr Nisha Bansal, Kidney Research Institute, University of Washington, 908 Jefferson St, 3rd floor, Seattle, WA 98104, USA; nbansal{at}uw.edu

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) <60 mL/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.

https://doi.org/10.1136/heartjnl-2016-309842

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    Footnotes

    • Contributors Design of study was led by NB, AS, FM, RTB, DHS, DJM, JHG, KR, ST, SHS, AD and ASG. Data analysis and interpretation of data were led by NB, AS, GHT, SHS, AD and ASG; manuscript preparation led by NB, AS, GHT, SHS and ASG; critical review and editing of manuscript by NB, AS, FM, RTG, DHS, DJM, JHG, KR, GHT, SHS, AD, ASG, RG-M, SH, JH, AK, PS, PV, HV and ASG.

    • Funding This work was supported by the following grants: R56HL121069, K23 DK088865, U19 HL91179-01, HHSA290-2005-0033-I-TO8-WA.

    • Competing interests None.

    • Ethics approval University of Washington Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.