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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Effect of end-stage renal failure and hemodialysis on mortality rates in implantable cardioverter-defibrillator recipients.
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Effect of end-stage renal failure and hemodialysis on mortality rates in implantable cardioverter-defibrillator recipients.

机译：终末期肾衰竭和血液透析对植入式心脏复律除颤器接受者死亡率的影响。

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摘要

Background: Most defibrillator (ICD) trials have excluded patients on hemodialysis (HD). It is therefore not known whether the ICD, when indicated, confers the same mortality benefit to HD and non-HD patients. Method: HD patients implanted with an ICD from July 2001 to June 2004 were matched by age, gender, left ventricular ejection fraction (LVEF), and class of heart failure to non-HD ICD recipients. Results: Forty-six (16 on HD) patients (age = 65 +/- 15 yrs, LVEF 30 +/- 14%, 44% in class III-IV HF) were followed for a mean of 30 +/- 16 months (range, 4-61 months) after ICD implantation. During this period, 12/16 HD versus 9/30 non-HD patients died (P = 0.006). The two-year mortality rates were 54% and 29% in the HD and non-HD groups, respectively (P = 0.01). After correcting for age, gender, race, LVEF, class of HF, and ICD indication (primary vs. secondary prevention) in a Cox regression model, HD remained a significant predictor of the time to death (HR = 2.9, adjusted P = 0.023). Conclusion: Despite having an ICD, HD patients have approximately a three-fold increase in total mortality and may therefore not extract the same survival benefits from the ICD as their non-HD counterparts. If duplicated in larger randomized trials, these results may demonstrate the futility of implanting defibrillators in HD patients.
机译：背景：大多数除颤器（ICD）试验都将接受血液透析（HD）的患者排除在外。因此，尚不清楚ICD是否在给HD和非HD患者带来相同的死亡率益处时使用。方法：将2001年7月至2004年6月间植入ICD的HD患者与非HD ICD接受者的年龄，性别，左心室射血分数（LVEF）和心力衰竭的类别相匹配。结果：四十六名（16名HD）患者（年龄= 65 +/- 15岁，LVEF 30 +/- 14％，III-IV级HF为44％），平均随访30 +/- 16个月ICD植入后（4-61个月）。在此期间，有12/16 HD患者与9/30非HD患者死亡（P = 0.006）。 HD组和非HD组的两年死亡率分别为54％和29％（P = 0.01）。在Cox回归模型中校正了年龄，性别，种族，LVEF，HF类别和ICD适应症（一级预防与二级预防）后，HD仍是死亡时间的重要预测指标（HR = 2.9，校正后的P = 0.023 ）。结论：尽管患有ICD，但HD患者的总死亡率大约增加了三倍，因此可能无法从ICD中获得与非HD患者相同的生存优势。如果在较大的随机试验中重复使用，则这些结果可能证明在HD患者中植入除颤器是徒劳的。

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