Herzog Charles A, Li Shuling, Weinhandl Eric D, Strief Jeremy W, Collins Allan J, Gilbertson David T
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Kidney Int. 2005 Aug;68(2):818-25. doi: 10.1111/j.1523-1755.2005.00462.x.
Sudden cardiac death is the single largest cause of mortality in dialysis patients. There are no published data on the use or survival impact of implantable cardioverter defibrillators (ICDs) in dialysis patients. The objective of this retrospective cohort study was to determine ICD use in dialysis patients and impact on survival.
Dialysis patients hospitalized from 1996 to 2001 for ventricular fibrillation/cardiac arrest, having ICD implantation within 30 days of admission, discharged alive, and surviving at least 30 days from admission were identified from the 100% end-stage renal disease (ESRD) sample of the Medicare database. Long-term survival was estimated by life-table method. Impact of independent predictors on survival was examined in a comorbidity-adjusted Cox model and a propensity model.
There were 460 patients (7.6%) with ICD and 5582 patients (92.4%) without ICD. Estimated 1-, 2-, 3-, 4-, and 5-year survivals after day 30 of admission in the ICD group were 71%, 53%, 36%, 25%, and 22%, respectively; in the no-ICD group, 49%, 33%, 23%, 16%, and 12% (P < 0.0001). ICD implantation was independently associated with a 42% reduction in death risk [relative risk 0.58 (95% CI 0.50, 0.66)]. In the propensity model, the relative risks of death for the lower, middle, and upper third propensity groups were 0.45 (0.26, 0.81), 0.61 (0.45, 0.84), and 0.65 (0.55, 0.76), respectively. The C statistic for the propensity model equaled 0.81.
In dialysis patients, ICD therapy is apparently underused. ICD implantation in cardiac arrest survivors on dialysis is associated with greater survival.
心脏性猝死是透析患者死亡的单一最大原因。关于植入式心脏复律除颤器（ICD）在透析患者中的使用情况或对生存的影响，尚无公开数据。这项回顾性队列研究的目的是确定ICD在透析患者中的使用情况及其对生存的影响。
从医疗保险数据库的100%终末期肾病（ESRD）样本中，识别出1996年至2001年因室颤/心脏骤停住院、在入院30天内植入ICD、存活出院且入院后至少存活30天的透析患者。采用寿命表法估计长期生存率。在合并症调整的Cox模型和倾向模型中，检验独立预测因素对生存的影响。
有460例患者（7.6%）植入了ICD，5582例患者（92.4%）未植入ICD。ICD组入院30天后估计的1年、2年、3年、4年和5年生存率分别为71%、53%、36%、25%和22%；未植入ICD组分别为49%、33%、23%、16%和12%（P<0.0001）。植入ICD与死亡风险降低42%独立相关[相对风险0.58（95%CI 0.50，0.66）]。在倾向模型中，低、中、高倾向组的死亡相对风险分别为0.45（0.26，0.81）、0.61（0.45，0.84）和0.65（0.55，0.76）。倾向模型的C统计量等于0.81。
在透析患者中，ICD治疗的使用明显不足。透析心脏骤停幸存者植入ICD与更高的生存率相关。
