Pun Patrick H, Hellkamp Anne S, Sanders Gillian D, Middleton John P, Hammill Stephen C, Al-Khalidi Hussein R, Curtis Lesley H, Fonarow Gregg C, Al-Khatib Sana M
Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
Nephrol Dial Transplant. 2015 May;30(5):829-35. doi: 10.1093/ndt/gfu274. Epub 2014 Nov 17.
Sudden cardiac death is the leading cause of death among end-stage kidney disease patients (ESKD) on dialysis, but the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in this population is uncertain. We conducted this investigation to compare the mortality of dialysis patients receiving a primary prevention ICD with matched controls.
We used data from the National Cardiovascular Data Registry's ICD Registry to select dialysis patients who received a primary prevention ICD, and the Get with the Guidelines-Heart Failure Registry to select a comparator cohort. We matched ICD recipients and no-ICD patients using propensity score techniques to reduce confounding, and overall survival was compared between groups.
We identified 108 dialysis patients receiving primary prevention ICDs and 195 comparable dialysis patients without ICDs. One year (3-year) mortality was 42.2% (68.8%) in the ICD registry cohort compared with 38.1% (75.7%) in the control cohort. There was no significant survival advantage associated with ICD [hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.66-1.13, log-rank P = 0.29]. After propensity matching, our analysis included 86 ICD patients and 86 matched controls. Comparing the propensity-matched cohorts, 1 year (3 years) mortality was 43.4% (74.0%) in the ICD cohort and 39.7% (76.6%) in the control cohort; there was no significant difference in mortality outcome between groups (HR = 0.94, 95% CI: 0.67-1.31, log-rank P = 0.71).
We did not observe a significant association between primary prevention ICDs and reduced mortality among ESKD patients receiving dialysis. Consideration of the potential risks and benefits of ICD implantation in these patients should be undertaken while awaiting the results of definitive clinical trials.
心脏性猝死是接受透析的终末期肾病（ESKD）患者的主要死因，但一级预防植入式心律转复除颤器（ICD）对该人群的益处尚不确定。我们开展此项研究以比较接受一级预防ICD的透析患者与匹配对照组的死亡率。
我们使用来自国家心血管数据注册库ICD注册系统的数据来选择接受一级预防ICD的透析患者，并使用“遵循指南-心力衰竭”注册系统来选择一个对照队列。我们采用倾向评分技术对ICD接受者和未接受ICD的患者进行匹配以减少混杂因素，并比较两组之间的总生存率。
我们确定了108例接受一级预防ICD的透析患者和195例未接受ICD的可比透析患者。ICD注册队列中的1年（3年）死亡率为42.2%（68.8%），而对照队列中的死亡率为38.1%（75.7%）。ICD未显示出显著的生存优势[风险比（HR）0.87，95%置信区间（CI）0.66 - 1.13，对数秩检验P = 0.29]。倾向匹配后，我们的分析纳入了86例ICD患者和86例匹配的对照。比较倾向匹配队列，ICD队列中的1年（3年）死亡率为43.4%（74.0%），对照队列中的死亡率为39.7%（76.6%）；两组之间的死亡率结果无显著差异（HR = 0.94，95% CI：0.67 - 1.31，对数秩检验P = 0.71）。
我们未观察到一级预防ICD与接受透析的ESKD患者死亡率降低之间存在显著关联。在等待确定性临床试验结果期间，应考虑这些患者植入ICD的潜在风险和益处。
