title: Effect of Advancing Age and Multiple Chronic Conditions on Mortality in Patients with End-Stage Renal Disease after Implantable Cardioverter-Defibrillator Placement.
abstract: BACKGROUND
  There is insufficient information on the effect that advancing age and multiple chronic conditions (MCC) have on mortality after placement of an implantable cardioverter-defibrillator in patients with end-stage renal disease (ESRD) vs non-ESRD.
  
  
  OBJECTIVE
  To assess whether a differential effect of age and MCC exists between ESRD and non-ESRD.
  
  
  METHODS
  Population-based, retrospective cohort study using data from the national Kaiser Permanente Cardiac Device Registry of patients who underwent placement of an implantable cardioverter-defibrillator between January 1, 2007, and December 31, 2013.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  Of 7825 patients with implantable cardioverter-defibrillator placement, ESRD-affected patients constituted 4.0% of the cohort (n = 311), were similar in age (p = 0.91), and presented with a larger comorbidity burden (3.3 ± 1.3 vs 2.4 ± 1.5, p < 0.001). The effect of advancing age (every 5 years) on mortality in the ESRD cohort (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.03-1.20) was less than in the non-ESRD cohort (HR = 1.28, 95% CI = 1.25-1.32). Similarly, the effect of each additional comorbidity in the ESRD cohort was less (HR = 1.04, 95% CI = 0.91-1.19) than in the non-ESRD group (HR = 1.20, 95% CI = 1.16-1.25). Lastly, ESRD was independently associated with a 3-fold greater hazard of mortality.
  
  
  CONCLUSIONS
  Advancing age and increasing number of MCC have a differential effect on mortality risk in patients with ESRD compared with their non-ESRD counterparts. Future studies should focus on assessment of nonlinear relationships of age, MCC, and naturally occurring clusters of MCC on mortality.
authors.affiliation: Cardiologist at the San Jose Medical Center in CA. ashok.krishnaswami@kp.org.
authors.forename: Ashok
authors.initials: A
authors.lastname: Krishnaswami
authors.affiliation: Group Leader for Surgical Outcomes and Analysis for Kaiser Permanente in San Diego, CA. mary.lou.kiley@kp.org.
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: Kiley
authors.affiliation: Project Manager for Surgical Outcomes and Analysis for Kaiser Permanente in San Diego, CA. faith.anthony@kp.org.
authors.forename: Faith F
authors.initials: FF
authors.lastname: Anthony
authors.affiliation: Senior Data Consultant for Surgical Outcomes and Analysis for Kaiser Permanente in San Diego, CA. yuexin.chen@kp.org.
authors.forename: Yuexin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Project Manager for Surgical Outcomes and Analysis for Kaiser Permanente in San Diego, CA. jason.x.chen@kp.org.
authors.forename: Jason
authors.initials: J
authors.lastname: Chen
authors.affiliation: Infectious Disease Specialist at the Vacaville Medical Center in Vallejo, CA. sumanth.rajagopal@kp.org.
authors.forename: Sumanth
authors.initials: S
authors.lastname: Rajagopal
authors.affiliation: Electrophysiologist at the Santa Clara Medical Center in CA. taylor.i.liu@kp.org.
authors.forename: Taylor I
authors.initials: TI
authors.lastname: Liu
authors.affiliation: Electrophysiologist at the Santa Clara Medical Center in CA. charlie.young@kp.org.
authors.forename: Charlie
authors.initials: C
authors.lastname: Young
authors.affiliation: Director of the Surgical Outcomes and Analysis Department at Kaiser Permanente in San Diego, CA. liz.w.paxton@kp.org.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Paxton
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology