Cardiovascular implantable electronic device leads in CKD and ESRD patients: review and recommendations for practice

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Cardiovascular implantable electronic devices (CIEDs) are vital for managing cardiac arrhythmias in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) on hemodialysis.
• The survival advantage of implantable cardioverter defibrillators (ICDs) for primary prevention in CKD/ESRD patients is less defined than in the general population.

Purpose of the Study:

• To review complications associated with transvenous CIED leads in hemodialysis patients.
• To explore alternative CIED lead strategies for mitigating risks in this population.
• To provide consensus recommendations for managing CIED and arteriovenous access complications.

Main Methods:

• Literature review and analysis of existing data on CIED complications in renal disease.
• Evaluation of the impact of transvenous leads on central vein stenosis and arteriovenous access.
• Assessment of infection rates and outcomes in patients with renal disease and CIEDs.

Main Results:

• Transvenous CIED leads are linked to central vein stenosis, complicating arteriovenous access and potentially requiring interventions.
• Patients with renal disease experience higher rates of CIED lead infections with poorer outcomes.
• Epicardial or nontransvenous CIED leads may decrease risks of central venous stenosis and infection.

Conclusions:

• Transvenous CIED leads present significant risks for hemodialysis patients, including central vein stenosis and infection.
• Alternative CIED lead technologies, such as epicardial leads, warrant consideration to reduce complications.
• Management strategies for CIED and hemodialysis access complications are crucial for this patient group.