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Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators.
- Source :
- Heart; Apr2017, Vol. 103 Issue 7, p537-545, 9p, 2 Charts, 3 Graphs
- Publication Year :
- 2017
-
Abstract
- <bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- IMPLANTABLE cardioverter-defibrillators
KIDNEY function tests
CARDIAC arrest
CORONARY heart disease treatment
PUBLIC health
CARDIAC arrest prevention
HEART failure treatment
PREVENTIVE health services
CHRONIC kidney failure
COMPARATIVE studies
ELECTRIC countershock
GLOMERULAR filtration rate
HEART physiology
LEFT heart ventricle
KIDNEYS
HEART failure
LONGITUDINAL method
RESEARCH methodology
MEDICAL cooperation
PROSTHETICS
COMPLICATIONS of prosthesis
RESEARCH
TIME
EVALUATION research
TREATMENT effectiveness
STROKE volume (Cardiac output)
EQUIPMENT & supplies
DIAGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 13556037
- Volume :
- 103
- Issue :
- 7
- Database :
- Complementary Index
- Journal :
- Heart
- Publication Type :
- Academic Journal
- Accession number :
- 121809153
- Full Text :
- https://doi.org/10.1136/heartjnl-2016-309842