title: Kidney function and appropriateness of device therapies in adults with implantable cardioverter defibrillators.
abstract: Patients with chronic kidney disease (CKD) have higher risk of sudden cardiac death; however, they may not receive implantable cardioverter defibrillators (ICDs), in part due to higher risk of complications. We evaluated whether CKD is associated with greater risk of device-delivered shocks/antitachycardia pacing (ATP) therapies among patients receiving a primary prevention ICD.
  
  
  
  We studied participants in the observational Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter Defibrillators. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Outcomes included all delivered shocks/ATPs therapies and type of shock/ATP therapies (inappropriate or appropriate, determined by physician adjudication) within the 3 years. We evaluated the associations between CKD and time to first device therapy, burden of device therapy, and inappropriate versus appropriate device therapy, adjusting for demographics, comorbidity, laboratory values and medication use.
  
  
  
  Among 2161 participants, 1066 (49.3%) had CKD (eGFR 44±11 mL/min/1.73 m2) at ICD implantation. During mean of 2.26±0.89 years, 9.8% and 18.5% of participants had at least one inappropriate and appropriate shock/ATP therapies, respectively. CKD was not associated with time to first shock/ATP therapies (adjusted HR 0.87, 95% CI 0.73 to 1.05), overall burden of shock/ATP therapies (adjusted relative rate 0.93, 95% CI 0.74 to 1.17) or inappropriate versus appropriate shock/ATP therapies (adjusted relative risk 0.88, 95% CI 0.68 to 1.14) compared with not having CKD.
  
  
  
  In adults receiving a primary prevention ICD, mild-to-moderate CKD was not associated with the timing, burden or appropriateness of subsequent device therapy. Potential concern for inappropriate ICD-delivered therapies should not preclude ICDs among eligible patients with CKD.
authors.affiliation: Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Szpiro
authors.affiliation: University of Colorado Hospital, Aurora, Colorado, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Masoudi
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Greenlee
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Oakland, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: Meyers Primary Care Institute, Worcester, Massachusetts, USA.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, California, USA.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Tabada
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, California, USA.
authors.forename: Sue Hee
authors.initials: SH
authors.lastname: Sung
authors.affiliation: Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA.
authors.forename: Ashveena
authors.initials: A
authors.lastname: Dighe
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassidy-Bushrow
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin, USA.
authors.forename: Romel
authors.initials: R
authors.lastname: Garcia-Montilla
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hammill
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hayes
authors.affiliation: Touro College, New York, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Kadish
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin, USA.
authors.forename: Param
authors.initials: P
authors.lastname: Sharma
authors.affiliation: University of Colorado Hospital, Aurora, Colorado, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Varosy
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin, USA.
authors.forename: Humberto
authors.initials: H
authors.lastname: Vidaillet
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, California, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000295:instrumentation*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left