Europace Advance Access originally published online on October 6, 2009
Europace 2009 11(11):1469-1475; doi:10.1093/europace/eup282
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ICD
Implantable cardioverter defibrillator therapy in chronic kidney disease: a meta-analysis
1 Department of Cardiology, University of Ioannina Medical School, 45110 Ioannina, Greece; 2 Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
Aims: Recent observational studies have shown that implantable cardioverter defibrillator (ICD) patients with chronic kidney disease (CKD) have increased mortality and therefore the value of device therapy in this group has been questioned. The purpose of this meta-analysis was to systematically analyse the effect of renal dysfunction on mortality of ICD patients.
Methods and results: Pubmed, Cochrane clinical trials database, and EMBASE were searched until December 2008. In addition, a manual search was performed using review articles, reference lists of papers, and abstracts from conference reports. Of the 90 initially identified studies, 11 observational studies with 3010 patients were analysed. The meta-analysis of these studies showed that CKD was associated with higher mortality risk (HR = 3.44, 95% CI 2.82–4.21, Z = 12.09, P < 0.001) while there were no significant differences between individual trials (P = 0.09, I2 = 37.8%). A subgroup analysis which included the four studies that used estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2 to define CKD showed a higher mortality in the CKD group as well (HR = 3.06, 95% CI 2.31–4.04, Z = 7.84, P < 0.001) without significant heterogeneity (P = 0.38, I2 = 5.2%).
Conclusion: Our meta-analysis suggests that CKD is associated with increased mortality in patients who receive ICD therapy. Undoubtedly, prospective studies are needed in order to elucidate the impact of different stages of CKD in this setting. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of ICD therapy candidates.
Key Words: Implantable cardioverter defibrillators, Arrhythmias, Heart failure, Chronic kidney disease, Renal disease, Renal failure, Mortality
* Corresponding author. Tel: +30 26510 09347, Fax: +30 26510 07017, Email: p.korantzopoulos{at}yahoo.gr; pan-kor{at}mailbox.gr
The first two authors contributed equally to this study.
Manuscript submitted 9 July 2009. Accepted after revision 3 September 2009.