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Table 1 The role of drugs/invasive therapies in the prevention and treatment of SCD in CKD patients

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]

  1. ABBREVIATIONS: SCD, sudden cardiac death; CKD, chronic kidney disease; MADIT II, Multicenter Automatic Defibrillator Implantation Trial-II; HR, hazard risk; OR, odds ratio; HF, heart failure; VALIANT, Valsartan in Acute Myocardial Infarction Trial; ICD, implanted cardioverter-defibrillator; ESRD, end-stage renal disease, RR, risk reduction.