Changes in renal function over time in patients with cardiac resynchronisation therapy
Beat A Schaer1, Lara Hitz, Christian Sticherling
1University of Basel Hospital, Department of Cardiology, Basel, SWITZERLAND; bschaer@uhbs.ch.
Insights
Cardiac resynchronisation therapy (CRT) with defibrillator back-up (CRT-D) can lead to a decline in kidney function over two years. While some patients experience improvement, a significant portion shows substantial deterioration in glomerular filtration rate (GFR).
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Cardiac resynchronisation therapy with defibrillator back-up (CRT-D) is a common treatment for heart failure.
- Renal dysfunction is prevalent in heart failure patients undergoing CRT-D.
- Previous studies on CRT-D's impact on renal function have yielded conflicting results and limited follow-up data.
Purpose of the Study:
- To evaluate the changes in glomerular filtration rate (GFR) at one and two years post-CRT-D implantation.
- To investigate the relationship between baseline renal function and GFR changes after CRT-D.
Main Methods:
- A cohort of 284 CRT-D patients with available creatinine levels at baseline and one year was analyzed.
- Glomerular filtration rate (GFR) was calculated using the Modification Diet in Renal Disease (MDRD) equation.
- Patients were stratified into four GFR stages, with 149 having two-year follow-up data.
Main Results:
- Mean GFR showed no significant change at one year (63 ± 24 to 60 ± 24 ml/min/1.73 m2, p=0.26).
- A significant decrease in mean GFR was observed at two years (60 ± 21 to 56 ± 21 ml/min/1.73 m2, p=0.04).
- GFR decreased in stages 1 and 2, remained stable in stage 3, and improved in stage 4; 42% experienced ≥10 ml/min/1.73 m2 decline, while only 15% improved.
Conclusions:
- Overall mean GFR declines at one and two years after CRT-D implantation.
- The extent of GFR change is influenced by the initial degree of renal function.
- A considerable proportion of patients face substantial GFR deterioration post-CRT-D.
Question Under Study:
Cardiac resynchronisation therapy (CRT) with defibrillator back-up (CRT-D) is widely used in selected patients with moderate/severe heart failure. Renal failure is common in these patients. Data on the impact of CRT on renal function are controversial and limited by short follow-up. The aim of this study was to describe changes in glomerular filtration rate (GFR) from baseline compared with 1 and 2 years after CRT implantation.
Methods:
A total of 284 CRT-D patients with creatinine levels at baseline and after 1 year were identified in two prospective registries. In 149 patients, levels after 2 years were available. GFR in ml/min/1.73 m2 was estimated with the Modification Diet in Renal Disease equation and patients stratified into GFR stages 1 to 4.
Results:
The population was predominantly male (75%), mean (± standard deviation) age was 61 ± 7 years and ejection fraction 24% ± 8 %. GFR was 63 ± 24 ml/min/1.73 m2 at implantation and 60 ± 24 ml/min/1.73 m2 after 1 year (p = 0.26). At the 2-year follow-up, GFR had decreased from 60 ± 21 to 56 ± 21 ml/min/1.73 m2 (p = 0.04). Mean GFR decreased in stages 1 and 2, remained stable in stage 3 and improved in stage 4 patients. After 2 years, GFR had decreased ≥10 ml/min/1.73 m2 in 42%, but improved in only 15% (p = 0.04).
Conclusions:
Overall, mean GFR in CRT-D patients decreases at 1 and 2 years after implantation, depending in part on the initial degree of renal function. However, the chance of further substantial deterioration (≥10 ml/min/1.73 m2) is considerable.
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