Rationale The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.Objective We aimed to identify the... Show moreRationale The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.Objective We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.Methods and results We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55-81 years, and a left ventricular ejection fraction of >= 35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 - T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference - 0.3; 95% CI - 1.1 to 0.6; P = 0.58). The LOT-R score difference was - 0.2 (4.1) in the ICD group compared with - 1.5 (4.0) in the control group (mean difference - 1.1 (0.8); 95% CI - 2.6 to 0.4; P = 0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.Conclusions In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up. Show less
Het doel van dit proefschrift was om onderzoek te verrichten naar (het voorkomen van) plotse hartdood bij dialysepati_nten. Een groot deel van deze promotie is opgebouwd rondom de Implantable... Show moreHet doel van dit proefschrift was om onderzoek te verrichten naar (het voorkomen van) plotse hartdood bij dialysepati_nten. Een groot deel van deze promotie is opgebouwd rondom de Implantable Cardioverter Defibrillators in Dialysis patients (ICD2) studie. Dit studieprotocol werd opgezet om onderzoek te doen naar de mogelijke voordelen van profylactische implantatie van ICD__s bij dialysepati_nten. Verschillende aspecten van plotse dood bij deze pati_ntenpopulatie werden geanalyseerd. Verder werd onderzoek verricht naar de incidentie en behandeling van complicaties van deze therapie, met daarbij in het bijzonder aandacht voor pati_nten met nierfalen. Op basis van dit proefschrift kan gesteld worden dat er verscheidene onderzoeksmiddelen zijn, zoals bijvoorbeeld het electrocardiogram, waarmee pati_nten met een verhoogd risico op (plots) overlijden ge_dentificeerd kunnen worden. In de toekomst zal onderzocht kunnen worden of er behandelstrategie_n zijn die voor deze pati_nten een overlevingsvoordeel kunnen bieden. De rol van profylactische ICD implantatie bij dialysepati_nten, wordt momenteel nog onderzocht in de ICD2 studie. Hoewel ICD__s mogelijk in pati_nten met nierfalen een overlevingsvoordeel zouden kunnen bieden, moet wel in het achterhoofd gehouden worden dat er een belangrijke incidentie van complicaties is en dat mogelijk, met name, pati_nten met nierfalen potentieel levensbedreigende complicaties kunnen ervaren Show less
Buiten, M.S.; Bie, M.K. de; Heijden, A.C. van der; Rotmans, J.I.; Bootsma, M.; Groeneveld, J.H.M.; ... ; Erven, L. van 2014
Background. Diastolic dysfunction is common among dialysis patients and is associated with increased morbidity and mortality. Novel echocardiographic speckle tracking strain analysis permits... Show moreBackground. Diastolic dysfunction is common among dialysis patients and is associated with increased morbidity and mortality. Novel echocardiographic speckle tracking strain analysis permits accurate assessment of left ventricular diastolic function, independent of loading conditions and taking all myocardial segments into account. The aim of the study was to evaluate the prevalence of diastolic dysfunction in chronic dialysis patients using this novel technique, and to identify its determinants among clinical and echocardiographic variables. Methods. Patients currently enrolled in the ICD2 study protocol were included for this analysis. Next to conventional echo measurements diastolic function was also assessed by global diastolic strain rate during isovolumic relaxation (SRIVR). Results. A total of 77 patients were included (age 67 ± 8 years, 74% male). When defined as E/SRIVR ≥236, the prevalence of diastolic dysfunction was higher compared to more conventional measurements (48% versus 39%). Left ventricular mass (OR 1.02, 95% CI 1.00-1.04, P = 0.014) and pulse wave velocity (OR 1.34, 95% CI 1.07-1.68, P = 0.01) were independent determinants of diastolic dysfunction. Conclusion. Diastolic dysfunction is highly prevalent among dialysis patients and might be underestimated using conventional measurements. Left ventricular mass and pulse wave velocity were the only determinants of diastolic dysfunction in these patients. Show less
