Background: Small retrospective analyses suggest that end-stage renal disease (ESRD) patients do not obtain as much of a survival benefit from an implantable cardioverter-defibrillator (ICD) as non-ESRD patients do. We aimed to assess the survival effect of an ICD in ESRD patients with left ventricular dysfunction. Methods: Data from two registries identified ESRD patients with an ICD and ESRD patients with left ventricular dysfunction (defined as ejection fraction <0.35). Cox proportional hazards regression was performed, including certain predefined covariates to assess the effect of an ICD on survival. Results: Overall survival in the full cohort was a median of 4.7 years with 20 deaths in the ICD group and 29 deaths in the no-ICD group. The median survival in the ICD group was 8.0 years and 3.1 years in the no-ICD group. Crude analysis showed a better survival in the ICD group as compared to the no-ICD group (p = 0.016). The multivariable analysis confirmed that the ICD group had significantly less all-cause mortality compared to the no-ICD group (HR: 0.40; 95% CI: 0.19, 0.82; p = 0.013). Conclusion: An ICD is associated with a higher survival in ESRD patients with left ventricular dysfunction. This result merits further study in a larger cohort of patients.

US Renal Data System 2009 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2009.
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
Wanner C, Krane V, Marz W, Olschewski M, Mann JF, Ruf G, Ritz E: Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238–248.
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Avidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–237.
Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP, Calkins H, Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, Levine JH: Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004;350:2151–2158.
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996;335:1933–1940.
Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.
Goldenberg I, Moss AJ, McNitt S, Zareba W, Andrews ML, Hall WJ, Greenberg H, Case RB: Relations among renal function, risk of sudden cardiac death, and benefit of the implanted cardiac defibrillator in patients with ischemic left ventricular dysfunction. Am J Cardiol 2006;98:485–490.
Part 4. Definition and classification of stages of chronic kidney disease. Am J Kidney Dis 2002;39:S46–S75.
Chen-Scarabelli C, Scarabelli TM: Chronic renal insufficiency is an independent predictor of mortality in implantable cardioverter-defibrillator recipients. Pacing Clin Electrophysiol 2007;30:371–376.
Cuculich PS, Sanchez JM, Kerzner R, Greenberg SL, Sengupta J, Chen J, Faddis MN, Gleva MJ, Smith TW, Lindsay BD: Poor prognosis for patients with chronic kidney disease despite ICD therapy for the primary prevention of sudden death. Pacing Clin Electrophysiol 2007;30:207–213.
Robin J, Weinberg K, Tiongson J, Carnethon M, Reddy M, Ciaccio C, Quadrini M, Hsu J, Fan J, Choi P, Kadish A, Goldberger J, Passman R: Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. Heart Rhythm 2006;3:1196–1201.
Turakhia MP, Varosy PD, Lee K, Tseng ZH, Lee R, Badhwar N, Scheinman M, Lee BK, Olgin JE: Impact of renal function on survival in patients with implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 2007;30:377–384.
Altman DG, Andersen PK: Calculating the number needed to treat for trials where the outcome is time to an event. BMJ 1999;319:1492–1495.
Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, Barre PE: Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47:186–192.
Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Cataliotti A, Seminara G, Stancanelli B, Malatino LS: Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients. J Am Soc Nephrol 2004;15:1029–1037.
Banerjee D, Ma JZ, Collins AJ, Herzog CA: Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload. Clin J Am Soc Nephrol 2007;2:1186–1190.
de Bie MK, Lekkerkerker JC, van DB, Gaasbeek A, van BM, Putter H, van EL, Bax JJ, Schalij MJ, Rabelink TJ, Jukema JW: Prevention of sudden cardiac death: rationale and design of the Implantable Cardioverter Defibrillators in Dialysis Patients (ICD2) Trial – a prospective pilot study. Curr Med Res Opin 2008;24:2151–2157.
Wase A, Basit A, Nazir R, Jamal A, Shah S, Khan T, Mohiuddin I, White C, Saklayen M, McCullough PA: Impact of chronic kidney disease upon survival among implantable cardioverter-defibrillator recipients. J Interv Card Electrophysiol 2004;11:199–204.
Aggarwal A, Wang Y, Rumsfeld JS, Curtis JP, Heidenreich PA: Clinical characteristics and in-hospital outcome of patients with end-stage renal disease on dialysis referred for implantable cardioverter-defibrillator implantation. Heart Rhythm 2009;6:1565–1571.
Dasgupta A, Montalvo J, Medendorp S, Lloyd-Jones DM, Ghossein C, Goldberger J, Passman R: Increased complication rates of cardiac rhythm management devices in ESRD patients. Am J Kidney Dis 2007;49:656–663.
Teruya TH, Abou-Zamzam AM Jr, Limm W, Wong L, Wong L: Symptomatic subclavian vein stenosis and occlusion in hemodialysis patients with transvenous pacemakers. Ann Vasc Surg 2003;17:526–529.
Chen L, Hay JW: Cost-effectiveness of primary implanted cardioverter defibrillator for sudden death prevention in congestive heart failure. Cardiovasc Drugs Ther 2004;18:161–170.
Sanders GD, Hlatky MA, Owens DK: Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med 2005;353:1471–1480.
Manns BJ, Taub K, Richardson RM, Donaldson C: To reuse or not to reuse? An economic evaluation of hemodialyzer reuse versus conventional single-use hemodialysis for chronic hemodialysis patients. Int J Technol Assess Health Care 2002;18:81–93.
Berger AK, Duval S, Krumholz HM: Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. J Am Coll Cardiol 2003;42:201–208.
Herzog CA, Li S, Weinhandl ED, Strief JW, Collins AJ, Gilbertson DT: Survival of dialysis patients after cardiac arrest and the impact of implantable cardioverter defibrillators. Kidney Int 2005;68:818–825.
Thompson RJ, McCullough PA, Kahn JK, O’Neill WW: Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors. Am J Cardiol 1998;81:17–21.
Canadian Organ Replacement Registry. Five-Year Survival in ESRD Patients on Dialysis, With or Without Diabetes, by Age, 2003–2007 period survival. Canadian Institute for Health Information, 2010.
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