Also, older adults are prone to higher complication rates, shorter life expectancies (and thus, fewer years during which they could derive benefit from an ICD), and varying preferences.S10.3-2 For these reasons, it is important to take a particularly nuanced and patient- centered approach to treating these patients. 10.4. Chronic Kidney Disease Patients with chronic kidney disease (CKD) are at an in- creased risk of SCD compared with the general popula- CLINICAL STATEMENTS AND GUIDELINES tion, yet the risk versus benefit of primary prevention ICDs has been unclear; data from observational stud- ies have been conflicting, and patients with moderate or severe CKD, especially patients with end-stage renal disease (ESRD) on dialysis were not included in the piv- otal RCTs of ICDs.S10.4-1 S10.4-5 Furthermore, prior data had significant limitations given that patients who received ICDs have been compared inconsistently with a control group with CKD that did not receive primary prevention ICDs and the degree of renal insufficiency likely influ- ences survival benefit.S10.4-6 Patients with CKD, especially ESRD on dialysis, appear to be at increased risk of ICD- related complications. A significant number of sudden deaths are unassociated with VA in this population.S10.4-7 Therefore, the ERC was asked to address the impact of ICDs on mortality in patients with CKD. The ERC conducted a specific analysis of 5 studies that explored renal dysfunction. A meta-analysis of these studies suggested that an association exists be- tween ICD implantation and improved survival.S10.4-8 An important limitation is that only 2 studies specifi- cally studied patients with ESRD and most data ana- lyzed were from observational studies.S10.4-8,S10.4-9 In view of these limitations, the writing committee concluded there was not enough data to inform a recommenda- tion on ICD implantation in patients with ESRD on di- alysis. 