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Mortality Following Defibrillator Implantation in Patients with Renal Insufficiency
Article first published online: 26 JUL 2006
Journal of Cardiovascular Electrophysiology
Volume 17, Issue 9, pages 940–943, September 2006
How to Cite
ECKART, R. E., GULA, L. J., REYNOLDS, M. R., SHRY, E. A. and MAISEL, W. H. (2006), Mortality Following Defibrillator Implantation in Patients with Renal Insufficiency. Journal of Cardiovascular Electrophysiology, 17: 940–943. doi: 10.1111/j.1540-8167.2006.00550.x
Dr. Reynolds is the recipient of grant 1 K23 HL077171 from the NHLBI.
Manuscript received 26 March 2006; Revised manuscript received 5 May 2006; Accepted for publication 8 May 2006.
- Issue published online: 26 JUL 2006
- Article first published online: 26 JUL 2006
- renal failure;
Introduction: Patients with renal insufficiency have an increased risk of atherosclerotic coronary artery disease, cardiovascular events, and sudden cardiac death. Due to under-representation of patients with renal disease in large clinical trials, outcomes of implantable cardioverter defibrillator (ICD) implantation in this group remain unclear.
Methods and Results: Inpatient and ambulatory records were reviewed for 741 consecutive patients undergoing 947 defibrillator implants or replacements at Department of Defense Medical Facilities. Demographics, medical history, and mortality were reviewed. The mean age of the cohort was 64 ± 14 years and 599 (80.8%) were male. There were 173 patients (23.3%) with chronic renal insufficiency, 22 (3.0%) undergoing hemodialysis, and 546 (73.7%) without reported renal disease. The mean number of annual hospital admissions for heart failure among patients with and without renal failure was 3.8 ± 4.0 versus 1.2 ± 1.9 (P < 0.0001), respectively. The 1-year survival for those without renal insufficiency was 96.6%, compared to 87.8% for those with chronic renal insufficiency, and 88.7% for those undergoing hemodialysis. Multivariate analysis demonstrated a significant association between mortality among ICD patients and renal insufficiency, independent of coexisting congestive heart failure, ischemic cardiomyopathy, and diabetes mellitus (P < 0.0001).
Conclusions: Among ICD recipients, those with renal insufficiency have a significantly higher mortality rate than those without renal insufficiency. Among a cohort of patients with ICDs, those with known renal insufficiency have higher rates of health care resource utilization and more heart failure admissions. Development of a national registry for ICDs should include data with regard to renal function.