From: Prevention of sudden cardiac death in patients with chronic kidney disease
DRUG/DEVICE | POPULATION | TYPE OF STUDY | NO. OF PTS. | RESULTS | LEVEL OF SIGNIFICANCE | REF. |
---|---|---|---|---|---|---|
BETA-BLOCKERS | CKD (eGFR of <75 ml/min/1.73 m2) with LV dysfunction | Post-hoc analysis | 1232 | MADIT II study. Reduced risk of arrhythmic mortality in HF patients with mild renal insufficiency. | HR 0.61. 95%CI; 0.38-0.99. | [60] |
BETA-BLOCKERS | HD patients who underwent cardiac arrest | Nested case–control cohort study | 729 | Significantly reduced risk of death with beta-blockers* at 24 h** at the 6-month time points***. Strongly predictive for survival. | * OR 0.32; 95%CI 0.17-0.61 ** p = 0.005 *** p < 0.001 | [62] |
CARVEDILOL | Dialysis patients with dilated cardiomyopathy | Prospective, randomized, placebo controlled | 114 | Reduced morbidity* and mortality** in dialysis patients with dilated cardiomyopathy. Carvedilol use is recommended in all dialysis patients with chronic HF. | * p < 0.00001 ** p < 0.01 | [61] |
ICD | ESRD patients and controls who had permanent pacemaker or ICD | Observational study | 41 with ESRD; 123 controls | Patients with renal insufficiency are more prone to develop ventricular tachyarrhythmia and receive appropriate ICD shocks2. | * p < 0.001 | [72] |
ICD | Patients with renal insufficiency and ICD | Prospective | 230 | Renal insufficiency is a strong predictor of ICD shocks and antitachycardia pacing. | p = 0.02 | [73] |
ICD | CKD patients who underwent ICD | Retrospective study | 35 with CKD (total 229) | In patients receiving an ICD for primary prevention of sudden death, CKD significantly reduced long-term survival. | HR 10.5; 95% CI 4.8-23.1; p = 0.0001 | [74] |
ICD | CKD with ICD* or eGFR < 60 mL/min/1.73 m2** with ICD | Meta-analysis | 3010 | CKD is associated with increased mortality in patients who receive ICD therapy. | HR = 3.44, 95% CI 2.82-4.21, p < 0.001 *HR = 3.06, 95% CI 2.31-4.04, p < 0.001 ** | [75] |
ICD | Dialysis patients with ventricular fibrillation/cardiac arrest and ICD | Retrospective cohort observational study | 460 (ESRD + ICD), 5582 without ICD | Estimated 1 to 5-year survival after ICD implantation was better than in the non-ICD group*. ICD implantation was independently associated with a 42% reduction in death risk** | * p < 0.0001 ** RR 0.58, 95%CI 0.50-0.66 | [76] |
ICD | CKD patients with ICD | Prospective study | - | The beneficial effect of an ICD for primary prevention of SCD in CKD patients depends primarily on the patient’s age and stage of renal disease. ICD implantation in stages I-II reduces mortality, but in more advanced stages, advantages are less pronounced and are age-dependent due to higher procedural risk and decreased life expectancy. | - | [78] |