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Updated: Jul 5, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiac Device Therapy in Patients with Chronic Kidney Disease: An Update
Bogdan Caba1,2, Laura Vasiliu1,2, Maria Alexandra Covic1
1Faculty of Medicine, "Grigore T. Popa" University of Medicine, 700115 Iasi, Romania.
Insights
Cardiovascular diseases and chronic kidney disease (CKD) share risks. Cardiac device therapy in CKD patients shows benefits for heart failure and mortality, but infection risk is higher.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Engineering
Background:
- Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are closely linked, increasing risks of adverse events.
- CKD patients experience a higher burden of arrhythmias and it impacts decisions on cardiac device therapy.
- Existing data on cardiac device therapy in CKD patients is limited, primarily from observational studies and case reports.
Purpose of the Study:
- To review the current evidence on cardiac device therapy in patients with chronic kidney disease.
- To evaluate the efficacy and safety of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) in CKD patients.
- To highlight the specific considerations and challenges of cardiac device implantation in the CKD population.
Main Methods:
- Literature review of observational studies and case reports focusing on CKD patients receiving cardiac device therapy.
- Analysis of data regarding the impact of CRT, ICDs, and CRT-D on mortality, heart failure symptoms, renal function, and infections.
- Examination of the increased need for cardiac pacing in dialysis patients.
Main Results:
- Cardiac resynchronization therapy (CRT) is linked to reduced mortality, improved heart failure symptoms, and better renal function in early CKD stages.
- Implantable cardioverter defibrillators (ICDs) significantly reduce mortality in CKD patients for secondary prevention of sudden cardiac death.
- Cardiac resynchronization therapy with defibrillator (CRT-D) is recommended for eligible patients. Dialysis patients show a three-fold higher need for pacing. CKD is an independent risk factor for cardiac device infections.
Conclusions:
- Cardiac device therapy offers significant benefits for cardiovascular outcomes in CKD patients, despite increased infection risks.
- Careful patient selection and monitoring are crucial for optimizing outcomes of cardiac device therapy in individuals with CKD.
- Further research is needed to establish definitive guidelines for cardiac device implantation and management in the diverse CKD population.
Abstract:
Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are frequently interconnected and their association leads to an exponential increase in the risk of both fatal and non-fatal events. In addition, the burden of arrhythmias in CKD patients is increased. On the other hand, the presence of CKD is an important factor that influences the decision to pursue cardiac device therapy. Data on CKD patients with device therapy are scarce and mostly derives from observational studies and case reports. Cardiac resynchronization therapy (CRT) is associated with decreased mortality, reduced heart failure symptoms, and improved renal function in early stages of CKD. Implantable cardioverter defibrillators (ICDs) are associated with a significant reduction in the mortality of CKD patients only for the secondary prevention of sudden cardiac death. Cardiac resynchronization therapy with defibrillator (CRT-D) is preferred in patients who meet the established criteria. The need for cardiac pacing is increased three-fold in dialysis patients. CKD is an independent risk factor for infections associated with cardiac devices.
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