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Chicago, IL - In a attendant study, dialysis patients who had implantable cardiac defibrillator (ICD) analysis were added acceptable to accept adapted shocks for ventricular tachycardia or ventricular fibrillation, but they additionally had worse adaptation compared with a nondialysis accomplice [1].
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Study columnist Dr Rod S Passman (Northwestern University Feinberg School of Medicine, Chicago, IL) said: "Being on dialysis was the greatest augur of application the accessory for a accurate tachyarrhythmia. However, alike admitting these accessories were in abode and were actuality acclimated [appropriately], dialysis patients still had a adaptation decidedly beneath than patients afterwards dialysis. In a sense, this is not awfully surprising, because we apperceive that dialysis patients accept a lot of aggressive comorbidities and that conceivably abbreviating the accident of abrupt afterlife with a defibrillator still leaves them accessible to dying from added diseases."
He added that back this was a attendant abstraction with inherent abstraction architecture biases, it could not acknowledgment the catechism of whether defibrillators can absolutely prolong activity in dialysis patients.
The abstraction will arise in the October 2006 affair of Affection Rhythm.
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Cardiac ache is the arch account of afterlife in dialysis patients, and 61% of all cardiac deaths in these patients are due to cardiac arrest and/or arrhythmia, the group, with aboriginal columnist Dr Jason Robin (Northwestern Memorial Hospital, Chicago, IL), writes. Current guidelines do not exclude dialysis patients from accepting ICD implants, yet ICD trials accept either afar these patients or not presented subgroup abstracts for them, they note.
The board aimed to appraise whether accepting end-stage renal ache (ESRD) was an absolute accident agency for adapted ICD therapy, which was authentic as shock and/or antitachycardia pacing for ventricular tachyarrhythmias. Patients were advised to accept ESRD if they were on dialysis afore article of the accessory and did not accept a branch displace during the abstraction aftereffect period. The study's accessory cold was to analyze abiding adaptation of ICD recipients with and afterwards ESRD.
The aggregation analyzed abstracts from 585 patients (mean age 63±15 years; 79% male) who were built-in with an ICD and accustomed aftereffect affliction at Northwestern Memorial Hospital from May 1992 to December 2003. Of the absolute cohort, 19 patients (3.2%) had ESRD. These 16 hemodialysis and three peritoneal dialysis patients had been on dialysis for a beggarly of 3.1±3.2 years afore article of the ICD.
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During the boilerplate aftereffect of 2.2±2.4 years, 156 patients (26%) accustomed adapted defibrillator shocks. Compared with patients afterwards ESRD, those with ESRD were added acceptable to accept adapted ICD analysis (47% vs 26%, p=0.05) and to accept the shocks eventually (1.8 vs 6.0 years; log-rank p=0.013).
On the added hand, the average adaptation afterwards ICD implant was beneath for the ESRD patients than for the patients afterwards ESRD (3.2 vs 7.4 years; log-rank p=0.009). The account of afterlife was accessible for six of the seven asleep dialysis patients; three died of sepsis, two died of affection failure, and one died of nonspecified cardiac arrest.
Study limitations accommodate its baby size, single-center population, and attendant design. The authors note, however, that use of ICDs in this citizenry is actual low. For example, Dr Charles Herzog (Minneapolis Medical Analysis Foundation in Minneapolis, MN) and colleagues showed afresh that alone 460 of 6042 (7.6%) dialysis patients in the United States Renal Abstracts System database who survived abrupt cardiac afterlife were built-in with a defibrillator; compared with the patients who did not accept an ICD, those who did had a 42% lower accident of afterlife [2]. Robin and colleagues address that admitting the bargain adaptation of dialysis patients who accustomed an ICD in their study, the allegation by Herzog and colleagues accentuate the abeyant account of ICDs aural the dialysis population.
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"The acceptable account from our abstraction is that those [dialysis] patients who died did not die from abrupt death," Passman said. "What I would appetite to accent is that conceivably in dialysis patients who are currently adumbrated to accept a defibrillator—patients who are on dialysis with low casting atom or who accept survived abrupt death—some may be too ailing to benefit. . . . I accept that the accident of abrupt afterlife persists alike in dialysis patients with added preserved casting fractions, and conceivably those are the patients who may account best from accepting a defibrillator."
He added that this is a different accommodating citizenry that has been abundantly abandoned in above cardiology trials, and their ante of abrupt afterlife are according to that of the post-MI citizenry to whom a abundant bulk of assets are devoted. "I anticipate that the cardiology association needs to accede distinctively advised trials in the dialysis population. It is a rapidly accretion accommodating citizenry with abundant prevalence of cardiovascular accident factors, coronary disease, and affection failure, and yet we apperceive actual little about how to prolong the lives of these patients. . . . This shows added assignment needs to be done—there is no doubt—but I additionally anticipate that there is the abeyant for abundant appulse in this population," he concluded.
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