title: Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population.
abstract: BACKGROUND
  The incidence of sudden death among dialysis patients is high, but end stage renal disease was an exclusion criterion in the trials that demonstrated the benefit of implantable cardioverter defibrillator (ICD) for sudden death prevention.
  
  
  METHODS
  Dialysis patients alive on January 2010 or starting dialysis between January 2010 and January 2013 were enrolled and retrospectively evaluated. Patients were divided into three groups: No-Indication, Indication-With ICD and Indication-Without ICD. Cox and Fine and Gray regression models were used to estimate the total and cause-specific (sudden or non-sudden) mortality hazard ratio (HR, HR(cpRisk)), respectively. Survival was defined as the time from start of dialysis to the time of death.
  
  
  RESULTS
  154/2072 patients (7.4%) had indication for ICD implantation and 52 (33.8%) of them received the device; 688 (33.2%) deaths were recorded. Mortality was different among groups [Indication-With ICD vs No-Indication: HR 1.59 (95% CI 1.06-2.38) and Indication-Without ICD vs No-Indication: HR 2.67 (95% CI 2.09-3.39, p < 0.001)]. 84/688 (12.2%) were sudden deaths. The cumulative incidence of sudden death was higher in patients with ICD indication [Indication-With ICD vs No-Indication HR(cpRisk) 3.21 (95% CI 1.38-7.40) and Indication-Without ICD vs No-Indication: HR(cpRisk) 4.19 (95% CI 2.38-7.39), p < 0.001], but also No-Indication patients showed a high rate of sudden death [8.5% (95% CI.6.5-10.9) at 8 years of follow-up].
  
  
  CONCLUSIONS
  Dialysis patients with ICD indication had a worse survival than No-Indication subjects and the prognosis was particularly poor for the Indication-Without ICD group. Sudden death incidence was much higher than in the general population, even among No-Indication subjects.
authors.affiliation: Nephrology Unit, San Gerardo Hospital, Monza, Italy; Department of Health Sciences, University of Milan-Bicocca, Italy. Electronic address: simonetta.genovesi@unimib.it.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Genovesi
authors.affiliation: Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Porcu
authors.affiliation: Department of Health Sciences, University of Milan-Bicocca, Italy.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Luise
authors.affiliation: Department of Health Sciences, University of Milan-Bicocca, Italy.
authors.forename: Hilary
authors.initials: H
authors.lastname: Riva
authors.affiliation: Department of Health Sciences, University of Milan-Bicocca, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Nava
authors.affiliation: Nephrology Unit, San Gerardo Hospital, Monza, Italy; Department of Health Sciences, University of Milan-Bicocca, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
authors.affiliation: Nephrology Unit, Bassini Hospital, Cinisello Balsamo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pozzi
authors.affiliation: Nephrology Unit, Ospedali Riuniti Hospital, Bergamo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ondei
authors.affiliation: Nephrology Unit, Sant'Anna Hospital, Como, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Minoretti
authors.affiliation: Nephrology Unit, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.affiliation: Nephrology Unit, Alessandro Manzoni Hospital, Lecco, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pontoriero
authors.affiliation: Nephrology Unit, Uboldo Hospital, Cernusco sul Naviglio, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Conte
authors.affiliation: Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.affiliation: Electrophysiology and Cardiac Pacing Unit, San Gerardo Hospital, Monza, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vincenti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003645:Death, Sudden / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult
keywords: End stage renal disease; Hemodialysis; Implantable cardioverter defibrillator; Mortality; Sudden death