Related Experiment Video
Updated: Dec 25, 2025
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study
Mohammad A Hossain1, Firas Ajam1, Hetavi Mahida1
1Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall, Neptune, NJ 07753, USA.
Insights
Nearly one-third of patients needing cardiac devices have advanced chronic kidney disease (CKD). This highlights the need for careful vascular access planning and considering leadless devices for patients with CKD.
Area of Science:
- Nephrology
- Cardiology
- Medical Devices
Background:
- Cardiovascular disease is a leading cause of mortality in chronic kidney disease (CKD) patients.
- Cardiac devices like pacemakers are often necessary but can complicate vascular access in CKD patients.
- Understanding CKD prevalence in this population is crucial for managing cardiac mortality.
Purpose of the Study:
- To determine the prevalence of CKD in patients undergoing cardiac device placement.
- To assess the progression of CKD in patients receiving cardiac devices.
Main Methods:
- Retrospective analysis of 688 patients undergoing cardiac device placement over 3 years.
- Assessment of demographic data, comorbidities, renal function, device type, and vascular access sites.
- CKD staging based on NKF-KDOQI guidelines; hemodialysis patients excluded.
Main Results:
- 33% of patients had advanced CKD (stages 3-5) at cardiac device placement.
- Most common devices included lead insertions, loop recorders, and generator changes.
- Subclavian and axillary veins were the most frequent vascular access sites.
Conclusions:
- A significant proportion of patients undergoing cardiac device placement have advanced CKD.
- Transvenous device placement may not be ideal due to future renal replacement therapy needs.
- Subcutaneous, leadless cardiac devices may offer a better alternative for CKD patients.
Background:
Cardiovascular issues (especially arrhythmia and sudden cardiac death) are one of the most common causes of mortality in patients with chronic kidney disease (CKD). To minimize cardiac mortality, these patients frequently require various cardiac devices, such as pacemakers, loop recorders, and defibrillators which can compromise their vascular access. In this study, we aim to determine the prevalence of CKD in patients undergoing cardiac device placement and their progression of CKD.
Methods:
Institutional review board approval was obtained for this study. A total of 688 patients undergoing cardiac device placement were included in this study over a 3-year period at Jersey Shore University Medical Center. Demographic characteristics, comorbidities, base-line renal functions during the procedure, types of cardiac devices, sites of vascular access and follow-up renal function when available were assessed retrospectively. Patients were categorized into CKD stages 1 - 5 based on the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines. The patients who were already on hemodialysis were excluded in this study.
Results:
The average age of the patient were 73.9 years with male predominance (60%). A total of 227 patients (33%) had estimated glomerular filtration rate (eGFR) < 60 mL/min consistent with the evidence of advanced-stage CKD (stages 3 - 5) at the time of cardiac device placement. The most common types of device placements were new insertion/replacement of atrial and ventricular leads (39.5%), loop recorder implantation (21.1%) and generator changes on an already implanted device (11%). Only 4% (28/688) had a leadless cardiac device placement. The most common access sites were subclavian (47.1%), axillary (32.3%) and femoral (12.2%).
Conclusions:
The present study demonstrated that nearly one-third of the patient undergoing cardiac device placement had an advanced degree of renal failure. Because CKD is a progressive disease, many of these patients might require renal replacement therapy in the future. Transvenous devices is not a good choice in this group of patients as they will ultimately require an arteriovenous fistula. Subcutaneous leadless cardiac device insertion might be a better option in patients with advanced CKD.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Chronic Kidney Disease III: Interprofessional Care
01:28Kidney Transplant I: Introduction