TY - JOUR
T1 - Outcomes of ICDs and CRTs in patients with chronic kidney disease
T2 - a meta-analysis of 21,000 patients
AU - Shurrab, Mohammed
AU - Ko, Dennis T.
AU - Zayed, Yazan
AU - Navaneethan, Sankar D.
AU - Yadak, Nour
AU - Yaseen, Abeer
AU - Kaoutskaia, Anna
AU - Qamhia, Waad
AU - Hamdan, Zakaria
AU - Haj-Yahia, Saleem
AU - Lee, Douglas S.
AU - Newman, David
AU - Healey, Jeff S.
AU - Harvey, Paula
AU - Crystal, Eugene
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
KW - Chronic kidney disease
KW - CRT
KW - ICD
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85050950124&partnerID=8YFLogxK
U2 - 10.1007/s10840-018-0424-1
DO - 10.1007/s10840-018-0424-1
M3 - Article (Academic Journal)
C2 - 30058056
AN - SCOPUS:85050950124
SN - 1383-875X
VL - 53
SP - 123
EP - 129
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 1
ER -