Effect of end-stage renal failure and hemodialysis on mortality rates in implantable cardioverter-defibrillator recipients.

Background: 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.

Method: 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.

Results: 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).

Conclusion: 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.