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Prognostic impact of chronic kidney disease and renal replacement therapy in ventricular tachyarrhythmias and aborted cardiac arrest

  • Kathrin Weidner
  • Michael Behnes
  • Tobias Schupp
  • Jonas Rusnak
  • Linda Reiser
  • Gabriel Taton
  • Thomas Reichelt
  • Dominik Ellguth
  • Niko Engelke
  • Armin Bollow
  • Ibrahim El-Battrawy
  • Uzair Ansari
  • Jorge Hoppner
  • Christoph A. Nienaber
  • Kambis Mashayekhi
  • Christel Weiß
  • Muharrem Akin
  • Martin Borggrefe
  • Ibrahim Akin
Original Paper

Abstract

Background

The study sought to assess the prognostic impact of chronic kidney disease (CKD) and renal replacement therapy (RRT) in patients with ventricular tachyarrhythmias and sudden cardiac arrest (SCA) on admission.

Methods

A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT), fibrillation (VF) and SCA on admission from 2002 to 2016. Non-CKD vs. “CKD without RRT”, and “CKD without RRT” vs. “CKD with RRT” were compared applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint defined as long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index and the composite endpoint of recurrent ventricular tachyarrhythmias, appropriate ICD therapies and cardiac death at 24 h.

Results

In 2686 unmatched high-risk patients with ventricular tachyarrhythmias and SCA, non-CKD was present in 46%, “CKD without RRT” in 46% and “CKD with RRT” in 8%. Each, VT and VF occurred in about one-third of CKD patients. Multivariable Cox regression models revealed that “CKD without RRT” (HR = 2.118; p = 0.001) and “CKD with RRT” (HR = 3.043; p = 0.001) patients were associated with the primary endpoint of long-term mortality at 2 years, which was also proven after propensity-score matching (non-CKD vs. “CKD without RRT”: 43% vs. 27%, log rank p = 0.001; HR = 1.847; “CKD without RRT” vs. “CKD with RRT”: 74% vs. 51%, log rank p = 0.001; HR = 2.129). The rates of secondary endpoints were higher for cardiac death at 24 h, in-hospital death at index and the composite of recurrent ventricular tachyarrhythmias, appropriate ICD therapies and  cardiac death at 24 h, respectively, for “CKD without RRT” and “CKD with RRT” patients. 

Conclusion

In patients presenting with ventricular tachyarrhythmias and aborted SCA on admission, the presence of CKD, especially combined with RRT, is independently associated with an increase of long-term all-cause mortality at 2 years, cardiac death at 24 h, in-hospital death and the composite of recurrent ventricular tachyarrhythmias, appropriate ICD therapies and  cardiac death at 24 h.

Keywords

Ventricular tachyarrhythmia Sudden cardiac arrest Chronic kidney disease Renal replacement therapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they do not have any conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kathrin Weidner
    • 1
  • Michael Behnes
    • 1
  • Tobias Schupp
    • 1
  • Jonas Rusnak
    • 1
  • Linda Reiser
    • 1
  • Gabriel Taton
    • 1
  • Thomas Reichelt
    • 1
  • Dominik Ellguth
    • 1
  • Niko Engelke
    • 1
  • Armin Bollow
    • 1
  • Ibrahim El-Battrawy
    • 1
  • Uzair Ansari
    • 1
  • Jorge Hoppner
    • 2
  • Christoph A. Nienaber
    • 3
  • Kambis Mashayekhi
    • 4
  • Christel Weiß
    • 5
  • Muharrem Akin
    • 6
  • Martin Borggrefe
    • 1
  • Ibrahim Akin
    • 1
  1. 1.First Department of Medicine, Faculty of Medicine MannheimUniversity Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/MannheimMannheimGermany
  2. 2.Clinic for Diagnostic and Interventional Radiology HeidelbergUniversity HeidelbergHeidelbergGermany
  3. 3.Royal Brompton and Harefield Hospitals, NHSLondonUK
  4. 4.Department of Cardiology and Angiology IIUniversity Heart Center FreiburgBad KrozingenGermany
  5. 5.Institute of Biomathematics and Medical Statistics, Faculty of Medicine Mannheim, University Medical Center Mannheim (UMM)Heidelberg UniversityMannheimGermany
  6. 6.Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany

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