Outcomes of ICDs and CRTs in patients with chronic kidney disease: a meta-analysis of 21,000 patients

Mohammed Shurrab*, Dennis T. Ko, Yazan Zayed, Sankar D. Navaneethan, Nour Yadak, Abeer Yaseen, Anna Kaoutskaia, Waad Qamhia, Zakaria Hamdan, Saleem Haj-Yahia, Douglas S. Lee, David Newman, Jeff S. Healey, Paula Harvey, Eugene Crystal

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
205 Downloads (Pure)

Abstract

Purpose: The efficacy of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in patients with chronic kidney disease (CKD) remains unclear. The aim of this meta-analysis is to explore the association between ICD/CRT and mortality in CKD patients. Methods: An electronic search was conducted using MEDLINE. We included studies that reported outcomes of interest in CKD patients stratified by the presence of ICD, CRT, or none. The primary outcome was all-cause mortality. Outcomes were pooled using random effects model. Odds ratios (OR) were reported for dichotomous variables. Results: The literature search resulted in 11 studies (observational studies) including 21,136 adult patients: seven studies compared ICD vs. no ICD and four studies compared CRT vs. ICD. All-cause mortality was significantly lower in the ICD group in comparison to that in the no ICD group (OR 0.66 (95% confidence interval [CI] 0.45; 0.98), P = 0.04). Among dialysis-only patients, all-cause mortality was significantly lower in the ICD group (OR 0.49 (95% CI 0.38; 0.64), P < 0.001). All-cause mortality was significantly lower in the CRT group in comparison to that in the ICD group (OR 0.73 (95% CI 0.57; 0.92), P = 0.01). Conclusions: The use of ICDs is associated with lower all-cause mortality in observational studies of CKD patients. CRT use was also associated with lower all-cause mortality in CKD patients in comparison to ICDs. A randomized controlled trial is required to definitively define the role of ICDs/CRTs in CKD patients.

Original languageEnglish
Pages (from-to)123-129
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
Volume53
Issue number1
Early online date30 Jul 2018
DOIs
Publication statusPublished - 1 Oct 2018

Keywords

  • Chronic kidney disease
  • CRT
  • ICD
  • Mortality

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