This study reviewed outcomes for patients receiving implantable cardioverter-defibrillators (ICDs) for primary or secondary prevention of sudden cardiac death. Among 3628 patients who received ICDs, 162 (4.5%) had end-stage renal disease (ESRD) requiring dialysis. For patients without dialysis, survival at a mean follow-up of 27.1 months was 86.5% for primary prevention and 82.0% for secondary prevention, with no significant difference. However, patients with ESRD had significantly worse survival for both primary (68.4%) and secondary (74.7%) prevention compared to non-dialysis patients. While one-year survival in ESRD patients was

1. Contemporary outcomes of primary and secondary prevention implantable cardioverter-
defibrillator implantation in patients with end-stage renal disease
Faisal M. Merchant, Maher A. Addish, Kimberly Kelly, Mary Casey, Abhinav Goyal, Angel R. Leon,
Mikhael F. El-Chami
Introduction: End-stage renal disease (ESRD) is associated worse long-term survival in primary
prevention (PP) implantable cardioverter-defibrillator (ICD) recipients. However, there is a paucity of data
on the impact of ESRD on secondary prevention (SP) ICDs.
Methods: We reviewed all patients undergoing ICD implantation at our institution from Jan. 2006 to
March 2014 (n=3628) and stratified them by presence of ESRD at the time of ICD implant. The primary
endpoint was all-cause mortality assessed by Kaplan-Meier estimates. Vital status was ascertained via
the social security death index and medical records review.
Results: At ICD implant, 162 patients (4.5%) had ESRD and among these, 134 ICDs were implanted for
PP and 28 for SP. In the non-dialysis cohort, 3030 devices were implanted for PP and 436 for SP. At a
mean follow-up of 27.1 months, survival in each of the four groups was: non-dialysis, PP 86.5%; non-
dialysis, SP 82.0%; ESRD, PP 68.4% and ESRD, SP 74.7% (Figure). There was no difference in survival
between PP and SP recipients in the non-dialysis (p=0.189) and ESRD groups (p=0.613). However,
compared to the non-dialysis group, survival was significantly worse among those with ESRD for both PP
and SP (p < 0.001).
Conclusions: In this large cohort, SP ICDs were not associated with worse long-term survival compared
to PP, likely resulting from the efficacy of contemporary adjunctive therapies in SP ICD recipients.
However, ESRD was associated with significantly worse survival in both PP and SP cohorts. Although
one-year survival in ICD recipients with ESRD was over 80%, improved risk stratification tools are needed
to identify dialysis patients most likely to benefit from ICDs.