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Published on: December 11, 2017
Cardiac resynchronization therapy in CKD: a systematic review
Neha Garg1, George Thomas, Gregory Jackson
1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Insights
Cardiac resynchronization therapy (CRT) improves kidney and heart function in patients with chronic kidney disease (CKD). Further research is needed to confirm its effects on mortality in this population.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) offers benefits for heart failure patients.
- This review focuses on CRT's impact on patients with chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2).
Purpose of the Study:
- To systematically review the effects of CRT on patients with CKD.
- To compare outcomes of CRT in CKD patients versus non-CKD patients.
Main Methods:
- Searched MEDLINE, Scopus, and conference abstracts (1990-2012) for observational studies and RCTs.
- Included studies comparing CKD patients with and without CRT, and CKD patients with CRT to non-CKD patients with CRT.
- Extracted and pooled data on mortality, eGFR, and left ventricular ejection fraction using a random-effects model.
Main Results:
- Eighteen studies (14 observational, 4 RCTs) were included.
- CRT showed modest improvement in eGFR (mean difference 2.30 ml/min/1.73 m(2)) and significant improvement in left ventricular ejection fraction (mean difference 6.24%) in CKD patients.
- Subgroup analysis of RCTs indicated lower rates of death or heart failure hospitalization with CRT in the CKD population. Survival outcomes varied between observational studies and RCTs when comparing CKD and non-CKD patients.
Conclusions:
- CRT enhances both left ventricular and renal function in heart failure patients with CKD.
- Further research is warranted to investigate CRT's effects on mortality in CKD patients, especially those with advanced kidney disease.
Background:
Cardiac resynchronization therapy (CRT) confers morbidity and mortality benefits to selected patients with heart failure. This systematic review examined effects of CRT in CKD patients (estimated GFR [eGFR] <60 ml/min per 1.73 m(2)).
Design, Setting, Participants, & Measurements:
MEDLINE and Scopus (from 1990 to December 2012) and conference proceedings abstracts were searched for relevant observational studies and randomized controlled trials (RCTs). Studies comparing the following outcomes were included: (1) CKD patients with and without CRT and (2) CKD patients with CRT to non-CKD patients with CRT. Mortality, eGFR, and left ventricular ejection fraction data were extracted and pooled when appropriate using a random-effects model.
Results:
Eighteen studies (14 observational studies and 4 RCTs) were included. There was a modest improvement in eGFR with CRT among CKD patients (mean difference 2.30 ml/min per 1.73m(2); 95% confidence interval, 0.33 to 4.27). Similarly, there was a significant improvement in left ventricular ejection with CRT in CKD patients (mean difference 6.24%; 95% confidence interval, 3.46 to 9.07). Subgroup analysis of three RCTs reported lower rates of death or hospitalization for heart failure with CRT (versus other therapy) in the CKD population. Survival outcomes of CKD patients (compared with the non-CKD population) with CRT differed among observational studies and RCTs.
Conclusions:
CRT improves left ventricular and renal function in the CKD population with heart failure. Given the increasing use of cardiac devices, further studies examining the effects of CRT on mortality in CKD patients, particularly those with advanced kidney disease, are warranted.
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