title: Survival after primary prevention implantable cardioverter-defibrillator placement among patients with chronic kidney disease.
abstract: BACKGROUND
  Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD).
  
  
  RESULTS
  Using the National Cardiovascular Data Registry ICD registry linked with the Social Security Death Master File, we assessed the rate of death after primary prevention ICD placement between January 1, 2006, and December 31, 2007, according to CKD stage. Using Cox models, we identified factors associated with death among patients with CKD. Compared with patients without CKD (n=26,056), those with CKD (n=21,226) were older, less commonly men, more often white, and more frequently had comorbid illness. Compared with patients without CKD, patients with a glomerular filtration rate 30 to 60, glomerular filtration rate <30, and end-stage renal disease on dialysis had a higher risk of death after ICD placement (hazard ratio, 2.08; 95% confidence interval, 1.99-2.18; P<0.0001; hazard ratio, 4.20; 95% confidence interval, 3.92-4.50; P<0.0001; and hazard ratio, 4.80; 95% confidence interval, 4.46-5.17; P<0.0001, respectively). Corresponding 1-year death rates were 4.4%, 9.1%, 20.2%, and 22.4%. Among patients with CKD, factors associated with increased risk of death included CKD severity, age >65 years, heart failure symptoms, diabetes mellitus, lung disease, serum sodium <140 mEq/L, atrial fibrillation or flutter, and a lower ejection fraction.
  
  
  CONCLUSIONS
  The risk of death after primary prevention ICD placement is proportional to CKD severity. Among patients with CKD, several factors are prognostically significant and could inform clinical decision making on primary prevention ICD candidacy.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.). p.hess@duke.edu.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hess
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Pun
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.L.H., A.S.H., E.D.P., G.D.S., H.R.A.-K., L.H.C., B.G.H., P.H.P., K.J.A., S.M.A.-K.); Department of Medicine, Duke University Medical Center, Durham, NC (P.L.H., A.S.H., E.D.P., P.H.P., S.M.A.-K.); Department of Medicine, Yale University, New Haven, CT (J.P.C.); and Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.).
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011322:Primary Prevention / Q000295:instrumentation*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: defibrillators, implantable; renal insufficiency, chronic