Elsevier

The American Journal of Cardiology

Volume 188, 1 February 2023, Pages 36-40
The American Journal of Cardiology

Effect of Implanted Defibrillator on Mortality in Patients With Chronic Kidney Disease

https://doi.org/10.1016/j.amjcard.2022.11.011Get rights and content

The beneficial role of implantable cardioverter defibrillators (ICDs) in patients with chronic kidney disease (CKD) is controversial. This meta-analysis aimed to evaluate the effect of ICD on mortality in patients with CKD. A literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2). The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary end point was all-cause mortality. The minimum duration of follow-up required for inclusion was 1 year. The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow-up was 39 months (12 to 81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log hazard ratio [HR] −0.247, standard error [SE] 0.101, p = 0.015). Heterogeneity: degree of freedom = 13 (p <0.01), I2 = 97.057; test for overall effect: Z = −2.431 (p = 0.015). When further stratified based on dialysis, patients with CKD without the need for dialysis had significantly lower mortality (log HR −0.211, SE 0.095, p = 0.026), with a similar trend in patients who underwent dialysis (log HR −0.262, SE 0.134, p = 0.051). ICD implantation is associated with a significant mortality benefit in patients with CKD.

Section snippets

Methods

There was a preplanned protocol for systematic review and results were reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses.6 There was an electronic search performed of the following databases: EBSCO CINAHL, Google Scholar, Ovid Embase, MEDLINE, and Web of Science. References of selected studies, along with other publications from the first and corresponding authors, were searched and included. The following Medical Subject Headings terms used for search: CKD, kidney

Results

Using the previously described search term criteria, the initial search yielded 834 studies. Of these, only 18 studies were included for full-text screening after excluding case reports, review articles, and editorials. Ultimately, 14 studies with 70,661 patients met the criteria and were included in the analysis (Figure 1). We included both observational and randomized trials. We included all patients with ICD alone or with resynchronization therapy.

The study population included 70,661

Discussion

The major finding of our study is that ICD implantation in patients with CKD was associated with a significant reduction in long-term all-cause mortality. This long-term mortality benefit was particularly evident in patients with CKD who were not on dialysis, but a similar trend was observed in patients who underwent dialysis.

CKD is an inflammatory condition and has been shown to cause myocardial inflammation, rendering the ventricular myocardium more arrhythmogenic.20 Moreover, this chronic

Authors Contributions

Conceptualization: Mohammed Al-Sadawi; Data curation: Mohammed Al-Sadawi and Hina Ijaz; Formal analysis: Mohammed Al-Sadawi and Mahmoud Alsaiqali; Funding acquisition: none; Investigation: roger Fan and Eric Rashba; Methodology: Faisal Aslam; Project administration: Eric Rashba; Resources: Faisal Aslam; Software: Faisal Aslam; Supervision: roger Fan and Eric Rashba; Validation: Mohammed Al-Sadawi and Faisal Aslam; Visualization: Mohammed Al-Sadawi and Faisal Aslam; Roles/Writing - original

Disclosures

The authors have no conflicts of interest to declare.

Guidelines statement

The systematic review was conducted with a protocol in accordance with the Preferred Reporting of Items for Systematic reviews and Meta-Analyses statement.

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