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Implantable cardioverter-defibrillators with end stage renal disease: Nationwide inpatient sample database results

Karam Ayoub1, Ethan Fry1, Meera Marji2

  • 1Department of Electrophysiology, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA.

Pacing and Clinical Electrophysiology : PACE
|November 22, 2021
PubMed

Insights

Patients with end-stage renal disease (ESRD) undergoing implantable cardioverter-defibrillator (ICD) therapy face higher risks for complications like bleeding and mortality. This study highlights increased post-procedure risks for ESRD patients receiving ICDs.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Patients with chronic kidney disease experience more complications after implantable cardioverter-defibrillator (ICD) therapy.
  • Real-world data on in-hospital complications for end-stage renal disease (ESRD) patients undergoing ICD therapy is limited.
  • This study investigates procedure-related complications in ESRD patients receiving ICDs.

Purpose of the Study:

  • To explore and quantify the in-hospital, procedure-related complications of ICD therapy in patients with end-stage renal disease (ESRD).
  • To compare complication rates between ESRD patients and those with normal renal function post-ICD implantation.

Main Methods:

  • A retrospective analysis of the Nationwide Inpatient Sample (NIS) database from 2010 to 2016.
  • Inclusion of ESRD patients who underwent inpatient ICD placement.
  • 1:2 propensity score matching to compare ESRD patients with those having normal renal function, analyzing outcomes like hemorrhage, transfusion, mortality, and length of stay.

Main Results:

  • ESRD patients showed significantly higher odds of postoperative hemorrhage (OR=1.67), blood transfusion (OR=3.88), mechanical complications requiring lead revision (OR=1.24), vascular injury (OR=2.02), and in-hospital mortality (OR=4.56).
  • ESRD patients experienced longer hospitalizations (11 vs. 7 days).
  • No significant difference in pericardial complications was observed between groups.

Conclusions:

  • Patients with ESRD undergoing inpatient ICD therapy face elevated risks for postprocedural complications.
  • These complications include hemorrhage, hematoma, need for blood transfusion, mechanical issues with lead revision, and in-hospital mortality.
  • The risk for pericardial complications was not significantly increased in ESRD patients.
Abstract

Keywords:
bleedingend stage renal diseaseimplantable cardioverter-defibrillatormortality

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