title: Primary prevention implantable cardioverter defibrillators in end-stage kidney disease patients on dialysis: a matched cohort study.
abstract: BACKGROUND
  Sudden cardiac death is the leading cause of death among end-stage kidney disease patients (ESKD) on dialysis, but the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in this population is uncertain. We conducted this investigation to compare the mortality of dialysis patients receiving a primary prevention ICD with matched controls.
  
  
  METHODS
  We used data from the National Cardiovascular Data Registry's ICD Registry to select dialysis patients who received a primary prevention ICD, and the Get with the Guidelines-Heart Failure Registry to select a comparator cohort. We matched ICD recipients and no-ICD patients using propensity score techniques to reduce confounding, and overall survival was compared between groups.
  
  
  RESULTS
  We identified 108 dialysis patients receiving primary prevention ICDs and 195 comparable dialysis patients without ICDs. One year (3-year) mortality was 42.2% (68.8%) in the ICD registry cohort compared with 38.1% (75.7%) in the control cohort. There was no significant survival advantage associated with ICD [hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.66-1.13, log-rank P = 0.29]. After propensity matching, our analysis included 86 ICD patients and 86 matched controls. Comparing the propensity-matched cohorts, 1 year (3 years) mortality was 43.4% (74.0%) in the ICD cohort and 39.7% (76.6%) in the control cohort; there was no significant difference in mortality outcome between groups (HR = 0.94, 95% CI: 0.67-1.31, log-rank P = 0.71).
  
  
  CONCLUSIONS
  We did not observe a significant association between primary prevention ICDs and reduced mortality among ESKD patients receiving dialysis. Consideration of the potential risks and benefits of ICD implantation in these patients should be undertaken while awaiting the results of definitive clinical trials.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Pun
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Middleton
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Ahmason-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies
keywords: cardiovascular disease; defibrillator; dialysis; end-stage kidney disease; sudden cardiac death