Right ventricular pacing burden and progression of renal failure in chronic kidney disease patients with permanent pacemakers

In patients with permanent pacemaker (PPM) implantation, chronic kidney disease (CKD) milieu increases the risk of pacing-induced cardiomyopathy and worse long-term survival. Conversely, whether high right ventricular (RV) pacing burden in these patients could potentially accelerate renal failure progression and lead to poor outcomes remains unexplored yet.

We analyzed the renal outcomes of advanced CKD (stage 3b-4) patients who received PPM implantation, identified from a multidisciplinary CKD longitudinal management program. RV pacing burden was defined as the average RV pacing percentage (RVP %) from pacemaker insertion to the event or censoring, logarithmically transformed into LogRVP %. RVP % ≥20 % was categorized as a high RV pacing burden group. The primary outcome was a composite of a ≥50 % decline in eGFR from baseline, a sustained eGFR ≤10 mL/min/1.73 m², initiation of dialysis, and death from renal causes.

A total of 90 patients with mean baseline eGFR 37.8 ± 15.3 mL/min/1.73 m² and mean averaged RVP % 30.8 % were analyzed over a median follow-up of 3.9 years. Twenty-six patients reached the composite outcome. Higher LogRVP % was significantly associated with the primary composite outcome (hazard ratio [HR]: 1.771, 95 % confidence interval [CI]: 1.096-2.860, p = 0.02), especially those with baseline eGFR <30 mL/min/1.73 m². Patients with RVP% ≥ 20 % faced a higher risk of primary composite outcome (HR: 2.907, 95 % CI: 1.263-6.687, p = 0.01).

Among advanced CKD patients who underwent PPM implantation, a higher RV pacing burden was significantly associated with an increased risk of poor renal outcomes.