Introduction: Outcomes in ESRD patients undergoing transvenous ICD implant are poor. The subcutaneous defibrillator (S-ICD) is often used in ESRD patients, but outcomes are unknown.
Hypothesis: Long-term outcomes are similar for those with and without ESRD undergoing S-ICD implantation.
Methods: This was a single center retrospective study comparing patients undergoing S-ICD implantation from 2010 to 2016 with ESRD to those without ESRD with a composite outcome of death and S-ICD explant. Survival analysis was performed with Kaplan Meier curves, log-rank tests, and Cox regression.
Results: 174 patients were included, 29 with ESRD and 145 without ESRD. Follow-up was longer for those without ESRD (median 23 months; IQR 11-49.5) then those with ESRD (median 15 months; IQR 6-27; p-value 0.01). The groups were similar regarding age (54 years; 95% CI 51-56; p-value 0.95), sex (71%; p-value 0.86), ICD indication (29% secondary prevention; p-value 0.86), EF (38%; 95% CI 35%-40%: p-value 0.08), and NYHA class III or IV heart failure (13%; p-value 0.16). There was no difference between groups for implant hematoma (p-value 0.07), S-ICD infection (p-value 0.42), hospitalization (p-value 0.17), appropriate shock (p-value 0.70), inappropriate shock (p-value 0.90), or death (p-value 0.21). There was a trend towards reduced explant free survival in those with ESRD in univariable analysis (HR 2.4; 95% CI 0.9-6.2) (figure). Other significant univariable predictors of the primary outcome included atrial fibrillation, hypertension, diabetes, age, inotrope use, and NYHA class. In multivariable analysis, only NYHA class was an independent predictor (HR 2.4; 95% CI 1.5-4.0; p-value < 0.01) and ESRD was not a significant predictor (HR 1.6; 95% CI 0.6-4.4; p-value 0.37).
Conclusions: Despite being at higher risk for procedural morbidity and subsequent mortality, ESRD patients treated with S-ICD had comparable complications and mortality. These data support the S-ICD in ESRD patients.