Cardiovascular disease accounts for 41% of all-cause mortality in end-stage renal disease (ESRD), with sudden cardiac death (SCD) accounting for two-thirds of these patients. Although implantable cardioverter-defibrillators (ICDs) prevent SCD, little is known about their efficacy in ESRD because such patients have been excluded from major randomized controlled trials (RCTs). Some small, single-center retrospective analyses suggest that ESRD patients may not benefit as much as normal renal function patients whereas other studies suggest the opposite. Given the gaps in our understanding of SCD in ESRD and the clinical equipoise regarding ICD efficacy, an RCT is the next logical step.