Renal dysfunction and clinical outcomes of patients undergoing ICD and CRTD implantation: data from the Israeli ICD registry.
BACKGROUND
Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial.


OBJECTIVE
We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation.


METHODS
Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy.


RESULTS
During the study period (July 2010-November 2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR < 30 mL/minute/1.73 m(2) (n = 54, 4.6%) were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m(2) was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5-19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1-7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ± 4.3 mL/minute/1.73 m(2) in ICD patients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m(2) in patients with CRTD (P = 0.2).


CONCLUSIONS
Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
Alon
A
Eisen
Cardiology Department, Rambam Medical Center, Bat Galim, Haifa, Israel.
Mahmoud
M
Suleiman
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
Boris
B
Strasberg
Cardiology Department, Western Galilee Hospital, Nahariya, Israel.
Ron
R
Sela
Cardiology Department, Hadassah Ein Karem Hospital, Jerusalem, Israel.
Shimon
S
Rosenheck
Cardiology Department, Ha'Emek Medical Center, Afula, Israel.
Nahum A
NA
Freedberg
Cardiology Department, Wolfson Medical Center, Holon, Israel.
Michael
M
Geist
Cardiology Department, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
Shlomit
S
Ben-Zvi
Cardiology Department, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
Ilan
I
Goldenberg
Cardiology Department, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
Michael
M
Glikson
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
Moti
M
Haim
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007557:Israel; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
cardiac resynchronization therapy; chronic kidney disease; heart failure; implantable cardioverter defibrillator; renal insufficiency