The implantable cardioverter defibrillator (ICD) reduces the risk of sudden cardiac death (SCD) and improves survival among patients with significant left ventricular dysfunction due to ischemic or non-ischemic cardiomyopathy and no or mild kidney disease.1 Among patients with kidney failure maintained on dialysis therapy, SCD is the largest contributor to mortality, accounting for a quarter of patient deaths, with an annual risk of about 5% to 7% per year, exceeding the rate in the general population by 20- to 30-fold.