Hreybe Haitham, Razak Eathar, Saba Samir
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2007 Sep;30(9):1091-5. doi: 10.1111/j.1540-8159.2007.00818.x.
Most defibrillator (ICD) trials have excluded patients on hemodialysis (HD). It is therefore not known whether the ICD, when indicated, confers the same mortality benefit to HD and non-HD patients.
HD patients implanted with an ICD from July 2001 to June 2004 were matched by age, gender, left ventricular ejection fraction (LVEF), and class of heart failure to non-HD ICD recipients.
Forty-six (16 on HD) patients (age = 65 +/- 15 yrs, LVEF = 30 +/- 14%, 44% in class III-IV HF) were followed for a mean of 30 +/- 16 months (range, 4-61 months) after ICD implantation. During this period, 12/16 HD versus 9/30 non-HD patients died (P = 0.006). The two-year mortality rates were 54% and 29% in the HD and non-HD groups, respectively (P = 0.01). After correcting for age, gender, race, LVEF, class of HF, and ICD indication (primary vs. secondary prevention) in a Cox regression model, HD remained a significant predictor of the time to death (HR = 2.9, adjusted P = 0.023).
Despite having an ICD, HD patients have approximately a three-fold increase in total mortality and may therefore not extract the same survival benefits from the ICD as their non-HD counterparts. If duplicated in larger randomized trials, these results may demonstrate the futility of implanting defibrillators in HD patients.
大多数植入式心脏除颤器（ICD）试验都将接受血液透析（HD）的患者排除在外。因此，尚不清楚ICD在有指征时，对接受HD治疗的患者和未接受HD治疗的患者是否具有相同的死亡率获益。
将2001年7月至2004年6月期间植入ICD的HD患者，按照年龄、性别、左心室射血分数（LVEF）和心力衰竭分级，与未接受HD治疗的ICD接受者进行匹配。
46例患者（其中16例接受HD治疗）（年龄 = 65±15岁，LVEF = 30±14%，44%为III-IV级心力衰竭）在植入ICD后平均随访30±16个月（范围4-61个月）。在此期间，16例接受HD治疗的患者中有12例死亡，30例未接受HD治疗的患者中有9例死亡（P = 0.006）。HD组和非HD组的两年死亡率分别为54%和29%（P = 0.01）。在Cox回归模型中校正年龄、性别、种族、LVEF、心力衰竭分级和ICD指征（一级预防与二级预防）后，HD仍然是死亡时间的显著预测因素（风险比 = 2.9，校正后P = 0.023）。
尽管植入了ICD，但HD患者的总死亡率仍增加了约两倍，因此可能无法从ICD中获得与未接受HD治疗的患者相同的生存获益。如果在更大规模的随机试验中得到重复验证，这些结果可能表明在HD患者中植入除颤器是无效的。
