At Japan’s Fujita University, researchers reported to Inside Precision Medicine that a new risk measurement may add a layer of accuracy in predicting sudden cardiac death. The measure, called estimated glomerular filtration rate (eGFR), defines which patients are eligible for the lifesaving implantable cardioverter defibrillators (ICDs).

Lead investigator Yoshihiro Sobue, Associate Professor at Fujita’s Health University, explained that the study was designed to identify risk factors for sudden cardiac death in over 1,500 patients who were hospitalized due to congestive heart failure and whether kidney function plays a role in SCD.

About eGFR

Glomerular filtration rate measures the ability of the kidneys to filter blood. Although the effectiveness of ICDs for congestive heart failure has been proven, current data does not include patients who have chronic kidney disease. The Fujita team set out to determine whether patients with kidney disease would benefit from ICDs, considering the risk of implanting the devices.

Current guidelines from the New York Heart Association suggest implanting an ICD in patients who have impaired left ventricular ejection fraction (LVEF) of greater than 35%. As yet, the possible benefits of ICDs for patients who have mild renal disfunction or moderate disfunction have not been determined as a result of conflicting analyses.

For similar reasons, previous research emphasized the ICDs failure to benefit hemodialysis patients.

Professor Sobue further explained the importance of determining whether renal dysfunction is a risk factor because patients classified as having moderate or severe renal dysfunction were not included in studies upon which the current guidelines were based.

The study offered several findings that have surfaced from the team’s new research:

• Renal dysfunction is considered an SCD risk predictor
• Risk prediction was improved when renal dysfunction was added
• The researchers discovered that 25% of cases began within the first three months after patients were discharged.

Aside from the findings, the research team was unable to determine why chronic kidney disease appears to be related to SCD. The team does, however, offer various possibilities.

• A term used to change the heart’s shape and size is called cardiac remodeling. It is further advanced in cases of chronic kidney disease.
• Patients with multiple diseases (comorbidities); A registry study of 47,000 patients who had prophylactic ICD implantation showed more concomitant disease when chronic kidney disease exists.

Professor Sobue concluded by saying that refining the criteria for ICD implantation presents an opportunity for improved prevention of SCD and the reduction of complications that arise from unnecessary ICD implantations.

You can read more about this important study over at Inside Precision Medicine.