title: Clinical Outcomes in Patients with Severe Renal Dysfunction Including Dialysis Following Defibrillator Implantation.
abstract: BACKGROUND
  Renal dysfunction is associated with increased mortality in heart failure (HF) patients. However, there are limited data regarding clinical and arrhythmic outcomes associated with implantable cardioverter defibrillator (ICD) therapy in this population.
  
  
  METHODS
  We evaluated outcomes associated with the severity of renal dysfunction with or without dialysis among 2,289 patients who were enrolled and prospectively followed up in the Israeli ICD Registry. The primary endpoint of the study was all-cause mortality. Secondary endpoints included cardiac mortality, HF hospitalization, non-cardiac hospitalization, and appropriate and inappropriate ICD therapy.
  
  
  RESULTS
  Severe renal dysfunction patients (estimated glomerular filtration rate<30 ml/min/1.73 m2; n=144 patients; 6%) were older, with higher comorbidities prevalence, and more likely to suffer from advanced HF. Among severe renal dysfunction patients, those on dialysis had a lower prevalence of wide QRS and complete left bundle branch morphology, resulting in lower cardiac resynchronization therapy defibrillator (CRTD) implantation rates. Dialysis was associated with an overall increased risk for all-cause mortality (hazard ratio (HR) 3.22; 95% CI 1.69-6.13; p<0.01) and for noncardiac hospitalizations (HR 2.80; p<0.001) compared to all other study patients. However, within the subgroup of patients with severe renal dysfunction, the presence of dialysis was not an independent risk factor for all-cause mortality (HR 0.99; p=0.97) as compared to non-dialysis. The rate of appropriate ICD therapy for ventricular tachyarrhythmias increased with declining renal function, with the highest rate observed among those undergoing dialysis.
  
  
  CONCLUSIONS
  The present findings suggest that dialysis does not significantly modify the adverse outcomes associated with severe renal dysfunction following ICD/CRTD implantation.
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bogdan
authors.forename: Eyal
authors.initials: E
authors.lastname: Nof
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.forename: Ron
authors.initials: R
authors.lastname: Sela
authors.forename: Shimon
authors.initials: S
authors.lastname: Rosenheck
authors.forename: Nahum
authors.initials: N
authors.lastname: Freedberg
authors.forename: Michael
authors.initials: M
authors.lastname: Geist
authors.forename: Shlomit
authors.initials: S
authors.lastname: Ben-Zvi
authors.forename: Moti
authors.initials: M
authors.lastname: Haim
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Suleiman
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012042:Registries; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology; D012720:Severity of Illness Index; D013318:Stroke Volume