title: Renal disease and cardiac mortality in survivors of sudden cardiac death.
abstract: OBJECTIVE
  Renal disease is associated with increased all-cause mortality and cardiovascular mortality. However, the role of ICD implantation on cardiac mortality in patients with renal disease has not been well studied. Implantable cardioverter-defibrillator (ICD) implantation is protective against cardiac death in a secondary prevention population with renal disease.
  
  
  METHODS
  The Antiarrhythmics Versus Implantable Cardioverter Defibrillators (AVID) Trial (n = 1016) was a multicentre trial comparing ICD (n = 507) and anti-arrhythmic drugs (AAD) (n = 509) for secondary prevention of life-threatening ventricular tachyarrhythmias. We performed a post-hoc analysis of the AVID trial using the National Heart, Lung, and Blood Institute limited access dataset. Individuals in the original AVID study with history of renal disease (n = 82) were included in this analysis. Outcomes of our analysis were cardiac death and all-cause mortality.
  
  
  RESULTS
  41 patients had renal disease in both the ICD and AAD arms. A total of 116 patients died in the ICD arm, while 162 died in the AAD arm. Renal disease was an independent predictor (HR, 95% CI) of cardiac death (1.967, 1.09-3.57, P = 0.02) and all-cause mortality (2.04, 1.23-3.39, P = 0.01) in the AAD arm. Renal disease was also a predictor of all-cause mortality in the ICD arm (1.75, 1.01-3.01, P = 0.04). However, renal disease did not influence cardiac death in the ICD arm.
  
  
  CONCLUSIONS
  Our study investigates the effect of ICD implantation in an entirely secondary prevention population with renal disease. ICD implantation appears to be equally protective against cardiac death in renal disease when compared to AAD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kizilbash
authors.forename: Palaniappan
authors.initials: P
authors.lastname: Manickam
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.forename: Samrat
authors.initials: S
authors.lastname: Bhat
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D017741:Survivors
chemical_list: D000889:Anti-Arrhythmia Agents