Impact of moderate to severe renal impairment on mortality and appropriate shocks in patients with implantable cardioverter defibrillators

Venkata (Mahesh) Alla, Kishlay Anand, Mandeep Hundal, Aimin Chen, Showri Karnam, Tom Hee, Claire B. Hunter, Aryan N. Mooss, Dennis J. Esterbrooks, Syed M. Mohiuddin

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Abstract

Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000-2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR <30mL/min; moderate CKD: GFR: 30-59mL/min; and mild or no CKD: GFR ≥ 60mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30-59mL/min and 5 fold higher risk with GFR <30mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR <30) compared to mild or no CKD group (2.8 versus 4.2yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

Original languageEnglish
Article number150285
JournalCardiology Research and Practice
Volume1
Issue number1
DOIs
StatePublished - 2010

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Implantable Defibrillators
Glomerular Filtration Rate
Chronic Renal Insufficiency
Shock
Kidney
Mortality
Survival
Dialysis
Linear Models
Maintenance
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b898ee5d20024693a8b3e14a824d05ee,
title = "Impact of moderate to severe renal impairment on mortality and appropriate shocks in patients with implantable cardioverter defibrillators",
abstract = "Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000-2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR <30mL/min; moderate CKD: GFR: 30-59mL/min; and mild or no CKD: GFR ≥ 60mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30-59mL/min and 5 fold higher risk with GFR <30mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR <30) compared to mild or no CKD group (2.8 versus 4.2yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.",
author = "Alla, {Venkata (Mahesh)} and Kishlay Anand and Mandeep Hundal and Aimin Chen and Showri Karnam and Tom Hee and Hunter, {Claire B.} and Mooss, {Aryan N.} and Esterbrooks, {Dennis J.} and Mohiuddin, {Syed M.}",
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T1 - Impact of moderate to severe renal impairment on mortality and appropriate shocks in patients with implantable cardioverter defibrillators

AU - Alla, Venkata (Mahesh)

AU - Anand, Kishlay

AU - Hundal, Mandeep

AU - Chen, Aimin

AU - Karnam, Showri

AU - Hee, Tom

AU - Hunter, Claire B.

AU - Mooss, Aryan N.

AU - Esterbrooks, Dennis J.

AU - Mohiuddin, Syed M.

PY - 2010

Y1 - 2010

N2 - Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000-2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR <30mL/min; moderate CKD: GFR: 30-59mL/min; and mild or no CKD: GFR ≥ 60mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30-59mL/min and 5 fold higher risk with GFR <30mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR <30) compared to mild or no CKD group (2.8 versus 4.2yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

AB - Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000-2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR <30mL/min; moderate CKD: GFR: 30-59mL/min; and mild or no CKD: GFR ≥ 60mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30-59mL/min and 5 fold higher risk with GFR <30mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR <30) compared to mild or no CKD group (2.8 versus 4.2yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

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