Table 1.

The role of drugs/invasive therapies in the prevention and treatment of SCD in CKD patients

DRUG/DEVICE	POPULATION	TYPE OF STUDY	NO. OF PTS.	RESULTS	LEVEL OF SIGNIFICANCE	REF.
BETA-BLOCKERS	CKD (eGFR of <75 ml/min/1.73 m2) with LV dysfunction	Post-hoc analysis	1232	MADIT II study. Reduced risk of arrhythmic mortality in HF patients with mild renal insufficiency.	HR 0.61. 95%CI; 0.38-0.99.	[60]
BETA-BLOCKERS	HD patients who underwent cardiac arrest	Nested case–control cohort study	729	Significantly reduced risk of death with beta-blockers* at 24 h** at the 6-month time points***. Strongly predictive for survival.	* OR 0.32; 95%CI 0.17-0.61 ** p = 0.005 *** p < 0.001	[62]
CARVEDILOL	Dialysis patients with dilated cardiomyopathy	Prospective, randomized, placebo controlled	114	Reduced morbidity* and mortality** in dialysis patients with dilated cardiomyopathy. Carvedilol use is recommended in all dialysis patients with chronic HF.	* p < 0.00001 ** p < 0.01	[61]
ICD	ESRD patients and controls who had permanent pacemaker or ICD	Observational study	41 with ESRD; 123 controls	Patients with renal insufficiency are more prone to develop ventricular tachyarrhythmia and receive appropriate ICD shocks2.	* p < 0.001	[72]
ICD	Patients with renal insufficiency and ICD	Prospective	230	Renal insufficiency is a strong predictor of ICD shocks and antitachycardia pacing.	p = 0.02	[73]
ICD	CKD patients who underwent ICD	Retrospective study	35 with CKD (total 229)	In patients receiving an ICD for primary prevention of sudden death, CKD significantly reduced long-term survival.	HR 10.5; 95% CI 4.8-23.1; p = 0.0001	[74]
ICD	CKD with ICD* or eGFR < 60 mL/min/1.73 m2** with ICD	Meta-analysis	3010	CKD is associated with increased mortality in patients who receive ICD therapy.	HR = 3.44, 95% CI 2.82-4.21, p < 0.001*HR = 3.06, 95% CI 2.31-4.04, p < 0.001**	[75]
ICD	Dialysis patients with ventricular fibrillation/cardiac arrest and ICD	Retrospective cohort observational study	460 (ESRD + ICD), 5582 without ICD	Estimated 1 to 5-year survival after ICD implantation was better than in the non-ICD group*. ICD implantation was independently associated with a 42% reduction in death risk**	* p < 0.0001 ** RR 0.58, 95%CI 0.50-0.66	[76]
ICD	CKD patients with ICD	Prospective study	-	The beneficial effect of an ICD for primary prevention of SCD in CKD patients depends primarily on the patient’s age and stage of renal disease. ICD implantation in stages I-II reduces mortality, but in more advanced stages, advantages are less pronounced and are age-dependent due to higher procedural risk and decreased life expectancy.	-	[78]

ABBREVIATIONS: SCD, sudden cardiac death; CKD, chronic kidney disease; MADIT II, Multicenter Automatic Defibrillator Implantation Trial-II; HR, hazard risk; OR, odds ratio; HF, heart failure; VALIANT, Valsartan in Acute Myocardial Infarction Trial; ICD, implanted cardioverter-defibrillator; ESRD, end-stage renal disease, RR, risk reduction.