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Trends in the Use and Complications of Cardiac Resynchronization Therapy Device Implantation in Chronic Kidney

Asim Kichloo1,2, Dhanshree Solanki3, Ronald Berger4

  • 1Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.

The Journal of Innovations in Cardiac Rhythm Management
|March 6, 2023
PubMed

Insights

Cardiac resynchronization therapy (CRT) device implantation trends shifted, with CRT pacemakers (CRT-Ps) increasing and CRT defibrillators (CRT-Ds) decreasing in patients with chronic kidney disease (CKD). Complications like hemorrhage increased mortality risk.

Area of Science:

  • Cardiology
  • Nephrology
  • Health Services Research

Background:

  • Limited large-scale data exist on cardiac resynchronization therapy (CRT) device implantation in patients with chronic kidney disease (CKD).
  • Understanding implantation trends and outcomes in this vulnerable population is crucial for clinical practice and health policy.

Purpose of the Study:

  • To examine the incidence of CRT device implantation in hospitalized patients with CKD.
  • To analyze the impact of CRT device implantation on hospital complications and patient outcomes.
  • To compare trends between CRT biventricular pacemakers (CRT-Ps) and CRT defibrillators (CRT-Ds).

Main Methods:

  • Analysis of the Nationwide Inpatient Sample (NIS) database from 2008-2014.
  • Identification of yearly trends in CRT device implantation among CKD patients.
  • Comparison of CRT-P and CRT-D implantation rates, comorbidities, and complication rates.

Main Results:

  • CRT-P implantations significantly increased in CKD hospitalizations (12.3% to 23.8%, P < .0001) from 2008-2014.
  • CRT-D implantations showed a consistent downward trend (87.7% to 76.2%, P < .0001) during the same period.
  • Hemorrhage or hematoma was the most frequent complication (2.7%); patients with complications had a 3.35-fold increased mortality risk (OR, 3.35; 95% CI, 2.18-5.16; P < .0001).

Conclusions:

  • CRT-P implantation is becoming more prevalent in CKD patients, while CRT-D rates are declining.
  • Periprocedural complications, particularly hemorrhage, are associated with significantly increased mortality risk in this population.
  • These findings highlight evolving treatment patterns and the importance of managing complications during CRT device implantation in CKD patients.

Keywords:
Cardiac resynchronization therapychronic kidney diseasedefibrillatorpacemaker

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