|The role of drugs/invasive therapies in the prevention and treatment of SCD in CKD patients|
|DRUG/DEVICE||POPULATION||TYPE OF STUDY||NO. OF PTS.||RESULTS||LEVEL OF SIGNIFICANCE||REF.|
|BETA-BLOCKERS||CKD (eGFR of <75 ml/min/1.73 m2) with LV dysfunction||Post-hoc analysis||1232||MADIT II study. Reduced risk of arrhythmic mortality in HF patients with mild renal insufficiency.||HR 0.61. 95%CI; 0.38-0.99.|||
|BETA-BLOCKERS||HD patients who underwent cardiac arrest||Nested case–control cohort study||729||Significantly reduced risk of death with beta-blockers* at 24 h** at the 6-month time points***. Strongly predictive for survival.||* OR 0.32; 95%CI 0.17-0.61 ** p = 0.005 *** p < 0.001|||
|CARVEDILOL||Dialysis patients with dilated cardiomyopathy||Prospective, randomized, placebo controlled||114||Reduced morbidity* and mortality** in dialysis patients with dilated cardiomyopathy. Carvedilol use is recommended in all dialysis patients with chronic HF.||* p < 0.00001 ** p < 0.01|||
|ICD||ESRD patients and controls who had permanent pacemaker or ICD||Observational study||41 with ESRD; 123 controls||Patients with renal insufficiency are more prone to develop ventricular tachyarrhythmia and receive appropriate ICD shocks2.||* p < 0.001|||
|ICD||Patients with renal insufficiency and ICD||Prospective||230||Renal insufficiency is a strong predictor of ICD shocks and antitachycardia pacing.||p = 0.02|||
|ICD||CKD patients who underwent ICD||Retrospective study||35 with CKD (total 229)||In patients receiving an ICD for primary prevention of sudden death, CKD significantly reduced long-term survival.||HR 10.5; 95% CI 4.8-23.1; p = 0.0001|||
|ICD||CKD with ICD* or eGFR < 60 mL/min/1.73 m2** with ICD||Meta-analysis||3010||CKD is associated with increased mortality in patients who receive ICD therapy.||HR = 3.44, 95% CI 2.82-4.21, p < 0.001*HR = 3.06, 95% CI 2.31-4.04, p < 0.001**|||
|ICD||Dialysis patients with ventricular fibrillation/cardiac arrest and ICD||Retrospective cohort observational study||460 (ESRD + ICD), 5582 without ICD||Estimated 1 to 5-year survival after ICD implantation was better than in the non-ICD group*. ICD implantation was independently associated with a 42% reduction in death risk**||* p < 0.0001 ** RR 0.58, 95%CI 0.50-0.66|||
|ICD||CKD patients with ICD||Prospective study||-||The beneficial effect of an ICD for primary prevention of SCD in CKD patients depends primarily on the patient’s age and stage of renal disease. ICD implantation in stages I-II reduces mortality, but in more advanced stages, advantages are less pronounced and are age-dependent due to higher procedural risk and decreased life expectancy.||-|||
ABBREVIATIONS: SCD, sudden cardiac death; CKD, chronic kidney disease; MADIT II, Multicenter Automatic Defibrillator Implantation Trial-II; HR, hazard risk; OR, odds ratio; HF, heart failure; VALIANT, Valsartan in Acute Myocardial Infarction Trial; ICD, implanted cardioverter-defibrillator; ESRD, end-stage renal disease, RR, risk reduction.
Franczyk-Skóra et al.
Franczyk-Skóra et al. BMC Nephrology 2012 13:162 doi:10.1186/1471-2369-13-162