ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR146

Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Dialysis Patients: A Report from the National Cardiovascular Data Registry

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pun, Patrick H., Duke University, Durham, North Carolina, United States
  • Parzynski, Craig S., Yale New Haven Health, New Haven, Connecticut, United States
  • Friedman, Daniel J., Duke University, Durham, North Carolina, United States
  • Sanders, Gillian, Duke University, Durham, North Carolina, United States
  • Curtis, Jeptha P., Yale University School of Medicine, New Haven, Connecticut, United States
  • Al-Khatib, Sana, Duke University, Durham, North Carolina, United States
Background

Dialysis patients are at high risk of infectious and vascular complications related to implantable cardioverter defibrillator (ICD) implantation; many have advocated for the preferential use of subcutaneous (S-ICD) over transvenous devices (TV-ICD) due to the potential benefits of reduced risk of blood stream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of S-ICD compared to TV-ICDs among dialysis patients in the United States

Methods

This was a retrospective analysis of 23,136 ICD implants among dialysis patients reported between 2012 and 2018 to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD registry. We first examined the utilization and patient and procedure characteristics of dialysis patients receiving S-ICD. Next, among dialysis patients eligible to receive an S-ICD, we examined trends in S-ICD adoption as a proportion of all ICD implants and compared in-hospital outcomes (death, complications) among S-ICD and TV-ICD recipients using inverse probability weighted estimators.

Results

Of all ICDs implanted among dialysis patients during the study period, 3,195 (13.81%) were S-ICD. Among eligible first-time ICD dialysis recipients, the proportion of S-ICDs utilized increased yearly from 10.3% in 2012 to 68.5% in 2018. Compared to TV-ICD recipients, S-ICD recipients were more likely to be black (42.6% vs. 34.3%) and undergo implantation in teaching hospitals (62.8% vs 53.2%). In the inverse probability weighted estimators analysis of 3,327 patients, compared to TV-ICD, dialysis patients receiving S-ICDs had a higher rate of in-hospital cardiac arrest (1.53% vs 0.36%, p=0.002); in-hospital complications ((2.4% vs 1.48% p=0.08) and length of hospitalization ((1.57 vs. 1.24 days, p=0.08) were not significantly different between the 2 groups.

Conclusion

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.

Funding

  • Private Foundation Support