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Cardiovascular implantable electronic devices in hemodialysis patients: prevalence and implications for arteriovenous

Theodore F Saad1, Waqas Ahmed, Karen Davis

  • 1Nephrology Associates, PA, Vascular Access Center, Newark, DE; Section of Renal & Hypertensive Diseases, Department of Medicine, Christiana Care Health System, Newark, DE.

Seminars in Dialysis
|May 28, 2014
PubMed

Insights

Cardiovascular implantable electronic devices (CIEDs) are common in hemodialysis patients. Ipsilateral CIEDs and arteriovenous access increase central venous interventions but do not significantly alter overall access circuit intervention rates.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Surgery

Background:

  • Cardiovascular implantable electronic devices (CIEDs) are frequently used in patients undergoing chronic hemodialysis.
  • CIED leads, often placed via the subclavian vein, can lead to venous stenosis and hypertension, complicating vascular access management.

Purpose of the Study:

  • To investigate the prevalence of CIEDs in hemodialysis patients.
  • To evaluate the impact of CIEDs, specifically implantable cardioverter-defibrillators (ICDs) and pacemakers, on the rates of interventions in hemodialysis access circuits and central veins.
  • To compare intervention rates based on the laterality of CIED and arteriovenous access.

Main Methods:

  • A retrospective review of 1235 chronic hemodialysis patients was conducted.
  • Data collected included CIED presence, type (ICD or pacemaker), and hemodialysis access type.
  • Intervention rates for access circuits and central veins were analyzed based on CIED and access laterality (ipsilateral vs. contralateral).

Main Results:

  • CIEDs were present in 10.5% of patients (75 ICDs, 54 pacemakers).
  • Overall access circuit intervention rates were similar between ipsilateral (1.53/AY) and contralateral (1.44/AY) CIED and arteriovenous access.
  • Central venous intervention rates were significantly higher in the ipsilateral group (0.59/AY) compared to the contralateral group (0.28/AY) (p < 0.001).

Conclusions:

  • CIEDs are highly prevalent in hemodialysis patients.
  • Ipsilateral CIED and arteriovenous access leads to increased central venous interventions compared to contralateral placement.
  • While central venous interventions are more frequent, overall access circuit intervention rates remain comparable, suggesting careful monitoring is needed for ipsilateral cases.

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