Cardiac Resynchronization Therapy in CKD Stage 4 Patients
Ulas Höke1, Mand J H Khidir2, Enno T van der Velde2
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands.
Clinical Journal of the American Society of Nephrology : CJASN
|September 27, 2015
Summary
Cardiac resynchronization therapy (CRT) improves renal function and long-term survival in patients with stage 4 chronic kidney disease (CKD). CRT response is linked to better outcomes, including improved estimated glomerular filtration rate (eGFR).
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure but excluded severe renal dysfunction patients in trials.
- Stage 4 chronic kidney disease (CKD) patients have limited data on CRT's renal and prognostic effects.
Purpose of the Study:
- To evaluate CRT's impact on renal function in stage 4 CKD patients.
- To assess CRT's effect on long-term prognosis in this population.
Main Methods:
- Retrospective study of 73 CRT patients and 18 implantable cardioverter-defibrillator (ICD) controls with stage 4 CKD.
- Echocardiographic and renal function assessments at baseline and 6 months.
- Long-term follow-up for defibrillator therapy, heart failure hospitalizations, and mortality.
Main Results:
- CRT patients showed improved estimated glomerular filtration rate (eGFR) compared to ICD controls (P=0.04).
- CRT responders (30%) had significantly greater eGFR improvement (P<0.001).
- CRT was associated with superior survival compared to ICD (P=0.03), with CRT response independently predicting better prognosis.
Conclusions:
- Approximately 30% of stage 4 CKD patients respond to CRT, a lower rate than typically seen.
- CRT improves clinical outcomes and renal function (eGFR) in stage 4 CKD.
- CRT response is a key predictor of improved long-term prognosis in this patient group.
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