You are here

Article Text

Article menu
Download PDFPDF
EBM verdict
General Medicine
Implantable cardioverter-defibrillators in dialysis patients
  1. Mark T Mills
  1. Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Mark T Mills, Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK; marktmills1{at}gmail.com

https://doi.org/10.1136/bmjebm-2019-111281

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    ​Patients with end-stage renal disease on dialysis are at a high risk of sudden cardiac death (SCD). The Implantable Cardioverter-Defibrillator in Dialysis Patients (ICD-2) trial studied the role of the primary prevention ICD in preventing death in dialysis patients with a left ventricular ejection fraction (LVEF) ≥35%.

    Compared with the general population, annual mortality rates are over 10-fold higher in patients with end-stage renal disease undergoing dialysis.1 A large proportion of deaths in dialysis patients are attributed to SCD.2 The annual incidence of SCD in haemodialysis patients is between 5% and 7%, compared with 4% in patients with heart failure, and 1.5%–2.7% in patients with chronic kidney disease not requiring dialysis.2 The increased risk of SCD is ascribed to a combination of proarrhythmogenic factors, including dialysis-induced haemodynamic stress and myocardial ischaemia, electrolyte and fluid shifts, left ventricular hypertrophy and fibrosis, and autonomic dysregulation.2 3

    A number of clinical trials have previously identified groups of patients at high risk of SCD who gain a mortality benefit from the insertion of an …

    View Full Text