Outcomes of Transvenous Lead Extraction in Patients With End-Stage Renal Disease

Patients with end-stage renal disease (ESRD) on hemodialysis are at increased risk for bacteremia, which may necessitate transvenous lead extraction (TLE) if a cardiac implantable electronic device (CIED) is present. Most data on outcomes of TLE in ESRD come from small, single-center studies.

The National Inpatient Sample database was analyzed to identify hospitalizations where patients underwent TLE between 2016 and 2021. Baseline demographics, comorbidities, and outcomes were stratified by history of ESRD.

We identified 98 115 weighted hospitalizations where patients underwent TLE, of which 5005 (5%) had a history of ESRD. Patients with ESRD were younger and had a higher prevalence of comorbidities including congestive heart failure, diabetes, hypertension, and liver dysfunction. Compared to those without ESRD, in-hospital mortality was significantly higher in patients with ESRD undergoing TLE (10.4% vs. 2.5%, p < 0.001). The incidence of vascular complications (including superior vena cava perforation) and cardiogenic shock was also higher in patients with ESRD, as was the length of stay and total hospitalization cost. Even after adjustment for baseline differences, in-hospital mortality after TLE remained significantly higher in patients with ESRD (adjusted odds ratio [ORs] 2.1, 95% confidence interval 1.6-2.7).

In a nationally representative cohort, unadjusted in-hospital mortality among patients with ESRD undergoing TLE is over 10%, and even after adjustment for covariates, patients with ESRD were more than twice as likely to die in the hospital compared to non-ESRD patients undergoing TLE. The increased availability of CIEDs without transvenous hardware may mitigate some of the long-term burden of device implantation in patients with ESRD.