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Abstract: ASN Annual Meeting -- San Francisco |
Herzog CA, Li S
Long-Term Survival of Dialysis Patients in the US with Implantable Cardioverter Defibrillators (ICD's) or Cardiac Resynchronization Therapy - Defibrillator (CRT-D) Devices.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:711A 2007
Few data exist on the long-term survival of dialysis pts following implantation of ICD (implantable cardioverter-defibrillator) or CRT-D (cardiac resynchronization therapy - defibrillator) devices. The comparative outcome of device use for primary versus secondary prevention of sudden cardiac death has not been studied in dialysis pts, a group at high risk for sudden death.
We searched the records of 1,801,298 pts in the United States Renal Data System database to identify 5612 dialysis pts receiving ICD (n= 4713) or CRT-D (n= 899) in 1996-2005. Secondary prevention (cardiac arrest/Vfib/Vtach) was indication for 3661 ICDs (78%) and 386.CRT-D (43%) devices. Long-term survival was estimated by life table method and independent predictors of death were examined in a comorbidity-adjusted Cox model.
Results: The entire cohort was 69% male, 69% white, 5% age 20-44, 31% age 45-64, 37% age 65-74, and 27% age 75+. Diabetes (DM) was the primary cause of renal failure in 46% and 67% of pts had DM. 23% of pts had hx of coronary revascularization, 52% hx AMI, and 94% hx CHF. The Table shows estimated survival. For CRT-D vs ICD there was no difference in survival for either primary prevention (HR 1.01 (0.85, 1.19)) or secondary prevention (HR 1.00 (0.86,1.19)) in a Cox model. There was also no difference in survival by implant indication: ICD (1y prevention) vs ICD (2y prevention) HR 1.05 (0.96, 1.16) and CRT-D (1y prevention) vs CRT-D(2y prevention) HR 1.03 (0.85, 1.24).
Conclusion: Dialysis pts receiving ICD
Survival (%) Months ICD (1Y prev) ICD (2Y prev) CRT-D (1Y prev) CRT-D (2Y prev) (n=1052) (n=3661) (n=513) (n=386) 3 85.2 85.0 85.3 84.4 6 74.4 75.2 72.3 73.8 1 2 60.0 60.2 56.7 58.5 24 39.9 38.8 39.9 37.5 36 25.5 27.1 21.2 21.3
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