Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population

Simonetta Genovesi, Luca Porcu, Maria Carmen Luise, Hilary Riva, Elisa Nava, Andrea Stella, Claudio Pozzi, Patrizia Ondei, Claudio Minoretti, Maurizio Gallieni, Giuseppe Pontoriero, Ferruccio Conte, Valter Torri, Antonio Vincenti

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Abstract

Background The incidence of sudden death among dialysis patients is high, but end stage renal disease was an exclusion criterion in the trials that demonstrated the benefit of implantable cardioverter defibrillator (ICD) for sudden death prevention. Methods Dialysis patients alive on January 2010 or starting dialysis between January 2010 and January 2013 were enrolled and retrospectively evaluated. Patients were divided into three groups: No-Indication, Indication-With ICD and Indication-Without ICD. Cox and Fine and Gray regression models were used to estimate the total and cause-specific (sudden or non-sudden) mortality hazard ratio (HR, HRcpRisk), respectively. Survival was defined as the time from start of dialysis to the time of death. Results 154/2072 patients (7.4%) had indication for ICD implantation and 52 (33.8%) of them received the device; 688 (33.2%) deaths were recorded. Mortality was different among groups [Indication-With ICD vs No-Indication: HR 1.59 (95% CI 1.06-2.38) and Indication-Without ICD vs No-Indication: HR 2.67 (95% CI 2.09-3.39, p <0.001)]. 84/688 (12.2%) were sudden deaths. The cumulative incidence of sudden death was higher in patients with ICD indication [Indication-With ICD vs No-Indication HRcpRisk 3.21 (95% CI 1.38-7.40) and Indication-Without ICD vs No-Indication: HRcpRisk 4.19 (95% CI 2.38-7.39), p <0.001], but also No-Indication patients showed a high rate of sudden death [8.5% (95% CI.6.5-10.9) at 8 years of follow-up]. Conclusions Dialysis patients with ICD indication had a worse survival than No-Indication subjects and the prognosis was particularly poor for the Indication-Without ICD group. Sudden death incidence was much higher than in the general population, even among No-Indication subjects.

Original languageEnglish
Pages (from-to)170-177
Number of pages8
JournalInternational Journal of Cardiology
Volume186
DOIs
Publication statusPublished - May 1 2015

Keywords

  • End stage renal disease
  • Hemodialysis
  • Implantable cardioverter defibrillator
  • Mortality
  • Sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Genovesi, S., Porcu, L., Luise, M. C., Riva, H., Nava, E., Stella, A., Pozzi, C., Ondei, P., Minoretti, C., Gallieni, M., Pontoriero, G., Conte, F., Torri, V., & Vincenti, A. (2015). Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population. International Journal of Cardiology, 186, 170-177. https://doi.org/10.1016/j.ijcard.2015.03.178