Preventative cardioverter defibrillator implantation is of little benefit to kidney dialysis patients

Placing an implantable cardioverter defibrillator (ICD) in kidney dialysis patients as a preventative measure is of little benefit. This device does not prevent premature death, according to researchers at Leiden University Medical Centre (LUMC) in the leading scientific journal Circulation.

The result of their prospective randomized trial of kidney dialysis patients settles a protracted debate among medical practitioners, researchers explain. "One half believed we should implant an ICD in all dialysis patients as a preventative measure, while the other half thought this intervention too drastic for such vulnerable patients. However, no one knew for sure. We have now investigated this for the first time in a large clinical trial," says Professor of Cardiology, Wouter Jukema. He initiated the study together with Prof. Ton Rabelink and Dr Joris Rotmans of the Nephrology division.

No difference between the groups

The results are clear. The researchers studied 188 kidney dialysis patients between the ages of 55 and 80, 97 of whom received an ICD. After an average period of seven years, the researchers saw no difference between the two groups in the occurrence of sudden cardiac death or death due to other causes. "The risk of death to kidney dialysis patients remains extremely high. On average, half of patients die within five years, most frequently from an infection. So unfortunately, implanting an ICD does not help reduce the mortality rate," according to PhD candidate Rohit Timal.

The researchers recommend including advice in international guidelines to the effect that there is no reason for implanting an ICD in kidney dialysis patients as a routine preventative measure. "By doing so, we can spare patients from unnecessary surgery and possible complications and save a lot of money," says Jukema.


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