Impact of Renal Dysfunction on Mortality and Appropriate Therapies in Patients with Implantable Cardioverter Defibrillators

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Background: Although renal dysfunction is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between renal dysfunction and prognosis in patients with implantable cardioverter-defibrillators (ICDs). Methods: We studied 130 consecutive patients (ischemic cardiomyopathy/non-ischemic cardiomyopathy: 59/71 patients, age: 66±10 years, left ventricular ejection fraction: 39±17%) receiving first-time ICDs from 1998 to 2011 at our center. Based on an index estimated glomerular filtration rate (eGFR), the patients were classified as end stage renal disease (ESRD): eGFR<15 mL/min (n=10); chronic kidney disease (CKD): eGFR: 15–59 mL/min (n=61); or normal renal function: eGFR ≥60 mL/min (n=59). The impact of eGFR on survival and appropriate therapies was assessed by using Kaplan-Meier method. Results: During follow-up period of 44±34 months, deaths and appropriate therapies were observed in 29 and 50 patients, respectively. Mortality was significantly higher in patients with ESRD (30%, p=0.001) and those with CKD (31%, p=0.038) when compared with those with normal renal function (12%). Appropriate therapies event rate did not differ among the three groups: 30% in patients with ESRD, 38% in those with CKD and 41% in those with normal renal function. Conclusions: Renal dysfunction may be associated with increased mortality in ICD receivers, however, ICD may benefit patients irrespective of renal dysfunction.