Turakhia Mintu P, Varosy Paul D, Lee Keane, Tseng Zian H, Lee Randall, Badhwar Nitish, Scheinman Melvin, Lee Byron K, Olgin Jeffrey E
Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, California 94143-1354, USA.
Pacing Clin Electrophysiol. 2007 Mar;30(3):377-84. doi: 10.1111/j.1540-8159.2007.00678.x.
Although chronic renal insufficiency (CRI) is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between CRI and survival in patients with implantable cardioverter-defibrillators (ICDs), particularly across a wide range of renal function.
We studied 507 consecutive patients receiving first-time ICDs from 1993-2003 at a single center. Preimplant serum creatinine measurements were used to determine glomerular filtration rate (GFR) and stage of chronic kidney disease (CKD). The primary outcome was time to death.
During a mean follow-up of 4 years, all-cause mortality through completion of follow-up increased stepwise by GFR stage (I: 16%, II: 20%, III: 35%; IV: 40%; V: 50%; P < 0.001 for trend). After multivariate adjustment, CRI was independently associated with death (HR = 1.7, P = 0.02), as were a serum creatinine >or=2.0 mg/dL (HR 2.5, P = 0.003) and the presence of end-stage renal disease (HR 6.8; P < 0.001). For every 10-unit decrease in GFR, the adjusted hazard of death increased 12% (P = 0.04).
The presence of CRI prior to implant is independently associated with increased mortality in patients receiving ICDs. The risk is proportional to the degree of renal dysfunction and is apparent even when GFR is only mildly reduced. Differences in mortality are observed within the first year of implant, and patients on dialysis are at highest risk. Because randomized trials of ICDs have not included large numbers of patients with moderate or severe renal disease, our findings may have important implications in prognosis and case selection of patients who otherwise meet current indications for ICD implantation.
尽管慢性肾功能不全（CRI）与心脏和非心脏死亡率增加相关，但关于CRI与植入式心脏复律除颤器（ICD）患者生存率之间的关系数据有限，尤其是在广泛的肾功能范围内。
我们研究了1993年至2003年在单一中心连续接受首次ICD植入的507例患者。植入前的血清肌酐测量值用于确定肾小球滤过率（GFR）和慢性肾脏病（CKD）分期。主要结局是死亡时间。
在平均4年的随访期间，随访结束时的全因死亡率随GFR分期逐步增加（I期：16%，II期：20%，III期：35%；IV期：40%；V期：50%；趋势P<0.001）。多因素调整后，CRI与死亡独立相关（HR=1.7，P=0.02），血清肌酐≥2.0mg/dL（HR 2.5，P=0.003）和终末期肾病的存在（HR 6.8；P<0.001）也是如此。GFR每降低10个单位，调整后的死亡风险增加12%（P=0.04）。
植入前存在CRI与接受ICD植入的患者死亡率增加独立相关。风险与肾功能不全程度成正比，即使GFR仅轻度降低时也很明显。在植入的第一年内观察到死亡率差异，透析患者风险最高。由于ICD的随机试验未纳入大量中度或重度肾病患者，我们的研究结果可能对符合当前ICD植入指征患者的预后和病例选择具有重要意义。
