Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators
Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center be...
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.4061/2010/150285 |
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| author | Venkata M. Alla Kishlay Anand Mandeep Hundal Aimin Chen Showri Karnam Tom Hee Claire Hunter Aryan N. Mooss Dennis Esterbrooks Syed M. Mohiuddin |
| author_facet | Venkata M. Alla Kishlay Anand Mandeep Hundal Aimin Chen Showri Karnam Tom Hee Claire Hunter Aryan N. Mooss Dennis Esterbrooks Syed M. Mohiuddin |
| author_sort | Venkata M. Alla |
| collection | DOAJ |
| description | Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000–2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30–59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30–59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock. |
| format | Article |
| id | doaj-art-c58de63b14544ce2a49834690623c58c |
| institution | Kabale University |
| issn | 2090-0597 |
| language | English |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiology Research and Practice |
| spelling | doaj-art-c58de63b14544ce2a49834690623c58c2025-02-03T05:59:25ZengWileyCardiology Research and Practice2090-05972010-01-01201010.4061/2010/150285150285Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter DefibrillatorsVenkata M. Alla0Kishlay Anand1Mandeep Hundal2Aimin Chen3Showri Karnam4Tom Hee5Claire Hunter6Aryan N. Mooss7Dennis Esterbrooks8Syed M. Mohiuddin9Division of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADepartment of Cardiology, University of California, San Diego, CA 92103, USADepartment of Internal Medicine, Cheyenne Regional Medical Center, Cheyenne, WY 82001, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADepartment of Internal Medicine, Creighton University Medical Center, Omaha, NE 68131, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USADivision of Cardiology, Creighton University Medical Center, 3006 Webster Street, Omaha, NE 68131, USABackground. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population. Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000–2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30–59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function. Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30–59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs). Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.http://dx.doi.org/10.4061/2010/150285 |
| spellingShingle | Venkata M. Alla Kishlay Anand Mandeep Hundal Aimin Chen Showri Karnam Tom Hee Claire Hunter Aryan N. Mooss Dennis Esterbrooks Syed M. Mohiuddin Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators Cardiology Research and Practice |
| title | Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators |
| title_full | Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators |
| title_fullStr | Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators |
| title_full_unstemmed | Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators |
| title_short | Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators |
| title_sort | impact of moderate to severe renal impairment on mortality and appropriate shocks in patients with implantable cardioverter defibrillators |
| url | http://dx.doi.org/10.4061/2010/150285 |
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