Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com Editor Marie Benz: What are the main findings of the study?

There is recent evidence to suggest that end-stage renal disease patients may not achieve the same mortality benefit as those without renal disease after placement of implantable cardioverter defibrillators (ICDs).  The purpose of our review was to stratify chronic kidney disease (CKD) patients who have undergone ICD placement according to the progression of CKD and to evaluate differences in mortality and adverse outcomes.

The main finding is that more advanced CKD may result in a reduced benefit from ICD therapy.  One potential mechanism for a reduction in benefit is considered to be the increased risk of nonarrhythmic death in patients with the most advanced CKD and heart failure class.  Increasing defibrillation thresholds have also been postulated as a mechanism, although more data is required to validate that statement.

Hemodialysis.com: Were any of the findings unexpected?

One important finding, although not completely unexpected, is the lack of representation of patients with advanced CKD and particularly end-stage renal disease in the major comparative ICD trials, which have played a pivotal role in guiding ICD placement indications.

Hemodialysis.com: What should clinicians and patients take away from your report? 

Clinicians should continue to use the ACC/AHA/HRS Guidelines for Device-Based Therapy as a framework for recommendations regarding ICD implantation. 

However, clinicians should also carefully consider age, heart failure status, infection and competing comorbidities such as CKD in making recommendations to the individual patient.

Patients should also understand that there are potential complications to an invasive procedure when multiple comorbidities are present.

Hemodialysis.com: What recommendations do you have for future research as a result of this study?  

Clinicians should continue to use the ACC/AHA/HRS Guidelines for Device-Based Therapy as a framework for recommendations regarding ICD implantation. 

However, clinicians should also carefully consider age, heart failure status, infection and competing comorbidities such as CKD in making recommendations to the individual patient.  

Patients should also understand that there are potential complications to an invasive procedure when multiple comorbidities are present.

Reference:

Prevention of sudden cardiac death in patients with chonic kidney disease: risk and benefits of the implantable cardioverter defibrillator.