title: Effect of end-stage renal failure and hemodialysis on mortality rates in implantable cardioverter-defibrillator recipients.
abstract: BACKGROUND
  Most defibrillator (ICD) trials have excluded patients on hemodialysis (HD). It is therefore not known whether the ICD, when indicated, confers the same mortality benefit to HD and non-HD patients.
  
  
  METHODS
  HD patients implanted with an ICD from July 2001 to June 2004 were matched by age, gender, left ventricular ejection fraction (LVEF), and class of heart failure to non-HD ICD recipients.
  
  
  RESULTS
  Forty-six (16 on HD) patients (age = 65 +/- 15 yrs, LVEF = 30 +/- 14%, 44% in class III-IV HF) were followed for a mean of 30 +/- 16 months (range, 4-61 months) after ICD implantation. During this period, 12/16 HD versus 9/30 non-HD patients died (P = 0.006). The two-year mortality rates were 54% and 29% in the HD and non-HD groups, respectively (P = 0.01). After correcting for age, gender, race, LVEF, class of HF, and ICD indication (primary vs. secondary prevention) in a Cox regression model, HD remained a significant predictor of the time to death (HR = 2.9, adjusted P = 0.023).
  
  
  CONCLUSIONS
  Despite having an ICD, HD patients have approximately a three-fold increase in total mortality and may therefore not extract the same survival benefits from the ICD as their non-HD counterparts. If duplicated in larger randomized trials, these results may demonstrate the futility of implanting defibrillators in HD patients.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Haitham
authors.initials: H
authors.lastname: Hreybe
authors.forename: Eathar
authors.initials: E
authors.lastname: Razak
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome