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Research Letter |

Prophylactic Defibrillators in Patients With Severe Chronic Kidney Disease

Sheldon M. Singh, MD1; Xuesong Wang, MSc2; Peter C. Austin, PhD2,3; Rulan S. Parekh, MD, MS4,5; Douglas S. Lee, MD, PhD2,3,6 ; for the Ontario ICD Database Investigators
[+] Author Affiliations
1Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
3Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
4Department of Medicine, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
5Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
6Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
JAMA Intern Med. 2014;174(6):995-996. doi:10.1001/jamainternmed.2014.1208.
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Heart failure (HF) and chronic kidney disease (CKD) are increasing in prevalence individually and in combination.1 It is unclear whether the survival benefits associated with prophylactic implantable cardioverter defibrillator (ICD) implantation in traditional populations extends to individuals with severe CKD (stage ≥4 or estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) given their underrepresentation in clinical trials2 and elevated risk of non–cardiac-related death.3 The absence of data and presence of competing risks complicates decision-making in this population. This study assessed the association between prophylactic ICD implantation and survival in individuals with severe CKD.

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Kaplan-Meier Curve for Survival in the Propensity-Matched Cohort After Implantable Cardioverter Defibrillator (ICD) Implantation
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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