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Changes in renal function over time in patients with cardiac resynchronisation therapy.

Beat A Schaer1, Lara Hitz, Christian Sticherling

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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).

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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.