Defibrillator Use in Dialysis Patients: National Cardiovascular Data Registry Report

Researchers conducted a retrospective analysis to evaluate trends and the use and in-hospital outcomes of subcutaneous implantable cardioverter defibrillators (S-ICD) compared with transvenous ICDs (TV-ICD) in dialysis patients in the United States.

The analysis included data on 23,136 implants in dialysis patients reported to the National Cardiovascular Data Registry ICD Registry between 2012 and 2018. The first analysis examined the utilization and patient and procedure characteristics of dialysis patients who received S-ICD; a secondary analysis used inverse probability weighted estimators to identity trends in adoption of S-ICD as a proportion of all ICD implants and compare in-hospital outcomes (death, complications) among DS-ICD and TV-ICD recipients.

Of the total of ICDs implanted during the study period, 13.81% (n=3195) were S-ICD. Among eligible first-time ICD dialysis recipients, there was a yearly increase in the proportion of S-ICDs, from 10.3% in 2012 to 68.5% in 2018. Recipients of S-ICDs were more likely to be black than recipients of TV-ICD implants (42.6% vs 34.3%) and to undergo implantation in teaching hospitals (62.8% vs 53.2%).

In the secondary analysis of 3327 patients, patients receiving S-ICDs had a higher rate of in-hospital cardiac arrest compared with patients receiving TV-ICDs (1.53% vs 0.36%; P=0.002). Patients receiving S-ICDs also had higher rates of in-hospital complications (2.4% vs 1.48%; P=0.08) and length of hospitalization (1.57 vs 1.24 days; P=0.08).

In summary, the researchers said, “There has been a steady increase in the utilization of S-ICD among dialysis patients in the United States. The increased risk of in-hospital cardiac arrest in S-ICD recipients could have been due to residual confounding and selection bias, but randomized clinical trials are needed to definitively compare the outcomes of TV-ICD with S-ICDs in dialysis patients.”

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Source: Pun PH, Parzynski CS, Friedman DJ, et al. Trends in use and in-hospital outcomes of subcutaneous implantable cardioverter defibrillators in dialysis patients: A report from the National Cardiovascular Data Registry. Abstract of a presentation at the American Society of Nephrology Kidney Week 2019 (Abstract TH-OR146), November 7, 2019, Washington, DC.