Table 1

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. [60]
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 [62]
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 [61]
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 [72]
ICD Patients with renal insufficiency and ICD Prospective 230 Renal insufficiency is a strong predictor of ICD shocks and antitachycardia pacing. p = 0.02 [73]
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 [74]
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** [75]
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 [76]
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. - [78]

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

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