Renal function and mortality following cardiac resynchronization therapy
Grace Lin1, Bernard J Gersh, Eddie L Greene
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Chronic kidney disease (CKD) significantly increases mortality risk in patients receiving cardiac resynchronization therapy (CRT). Identifying CKD is crucial for evaluating CRT candidates and predicting survival outcomes.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Patient selection for CRT can be challenging.
- Chronic kidney disease (CKD) is a known predictor of mortality in heart failure patients.
Purpose of the Study:
- To investigate the impact of CKD on mortality in patients undergoing CRT.
- To determine if CKD affects survival benefits after CRT.
Main Methods:
- Retrospective analysis of 482 patients who received CRT at Mayo Clinic (1999-2005).
- Patients were categorized based on CKD presence (GFR ≤60 mL/min/1.73 m²).
- Multivariate analysis was used to assess predictors of survival.
Main Results:
- 71% of patients had CKD and were older with higher anemia rates.
- Patients with CKD had significantly lower 3-year survival rates (57% vs. 72%).
- CKD was identified as an independent predictor of poorer survival post-CRT.
Conclusions:
- CKD is prevalent in patients undergoing CRT.
- CKD is associated with increased mortality in this patient group.
- CKD status should be considered when assessing patients for CRT eligibility and prognosis.
Aims:
Cardiac resynchronization therapy (CRT) improves outcomes in heart failure, yet selection of patients likely to have survival benefit is problematic. Chronic kidney disease (CKD) is an important determinant of mortality in patients with congestive heart failure therefore we sought to determine the impact of CKD on mortality benefit after CRT.
Methods And Results:
All CRT device implantations in patients not on dialysis at Mayo Clinic between January 1999 and December 2005 were included. Of 482 patients, 342 (71%) had CKD (defined as a glomerular filtration rate (GFR) of ≤60 mL/min/1.73 m(2)) at the time of device implantation. Patients with CKD were older (71 ± 10 vs. 63 ± 14 years, P < 0.01) than patients without CKD, and more often anaemic (12.70 ± 1.73 vs. 13.24 mg/L, P < 0.01), with similar ejection fraction (22 ± 8 vs. 23 ± 8%, P = 0.32). Survival was superior in patients with normal or mild renal dysfunction compared with patients with CKD (72 vs. 57% at 3 years, P < 0.01). After multivariate analysis, CKD remained a significant predictor of poor survival following CRT.
Conclusion:
Chronic kidney disease is common in patients undergoing CRT and associated with a higher mortality and should be considered when evaluating patients for CRT.
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