Cardiac Resynchronization Therapy in CKD

Garg, Neha; Thomas, George; Jackson, Gregory R.; Rickard, John; Nally, Joseph V.; Tang, W.H. Wilson; Navaneethan, Sankar D.

doi:10.2215/cjn.00750113

Cited by 32 publications

(28 citation statements)

References 44 publications

(64 reference statements)

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“…Similarly, there was a significant improvement in LVEF with CRT in CKD patients (mean difference 6.24%). Subgroup analysis of 3 randomized clinical trials reported lower rates of death or hospitalization for HF with CRT in the CKD population [23].…”

Section: Heart Failure Renal Function and Crtmentioning

confidence: 97%

Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

et al. 2015

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Section: Heart Failure Renal Function and Crtmentioning

confidence: 97%

Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

et al. 2015

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“…Worse renal function was also associated with worse long-term prognosis after CRT. Despite this, a systematic review by Garg et al 18 demonstrated that CRT in patients with CKD led to an improvement in left ventricular ejection as well as GFR. More studies are required to evaluate this further; however, this suggests a degree of reversibility in cardiorenal syndromes 1 and 2.…”

Section: Cardiac Resynchronisationmentioning

confidence: 99%

Cardiorenal syndrome: review of our current understanding

Hadjiphilippou

Kon

2015

J R Soc Med

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Renal and cardiac diseases are both prevalent and carry significant morbidity and mortality. They share common vascular risk factors and are physiologically interlinked. Dysfunction in one organ affects the other. Concurrent renal and cardiac disease is associated with a poor prognosis. This close relationship is reflected through cardiorenal syndrome. A classification system has been proposed; however, the underlying process is complex and multifactorial. Management of this syndrome focuses on improving heart function, reducing volume overload, and managing heart failure and chronic kidney disease. This, however, is challenging, limited by paucity of evidence and may lead to suboptimal therapy. Increased recognition of this syndrome should raise awareness in providing early therapy and avoiding adverse outcomes due to under-treatment. In this article, we provide an overview of our current understanding of cardiorenal syndrome, as well as its pathophysiology and treatment options.

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“…However, data on the effect of CRT in patients with severe renal dysfunction are scarce (5). Major CRT clinical trials excluded patients with severe renal dysfunction and only two small retrospective studies described the effect of CRT in this group of patients (5,10,11).…”

Section: Effect Of Crt On Renal Function In Patients With Severementioning

confidence: 99%

“…Unfortunately, there are no data regarding CRT response among patients with CKD stage 4 to compare with. The limited reverse remodeling capacity of the myocardium after CRT in these patients may be caused by a chronic damage on the basis of uremic toxins, calcium/phosphate abnormalities, and hypervolemic damage (water and sodium retention) that could lead to myocardial fibrosis, capillary rarefraction, and endothelial cell dysfunction (5,7,13,(33)(34)(35). Probably concomitant conditions, such as anemia, increased levels of catecholamines, activated renin-angiotensin-aldosterone system resulting in increased myocardial fibrosis, fluid retention, and increased afterload, might represent other important factors to limit the favorable effect of CRT in cardiac function (35).…”

Section: Effect Of Crt On Renal Function In Patients With Severementioning

confidence: 99%

“…Cardiac resynchronization therapy (CRT) is a well established HF treatment for patients with broad QRS duration, improving left ventricular (LV) function, reducing HF symptoms, and improving long-term prognosis (4). In addition, CRT has demonstrated to be associated with improvement of renal function (5)(6)(7)(8)(9)(10)(11). However, landmark trials excluded patients with severe renal dysfunction, and only few data are available on the effect of CRT in this particular population (10).…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Resynchronization Therapy in CKD Stage 4 Patients

Höke

Khidir

Velde

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiac resynchronization therapy (CRT) is a well established heart failure treatment that has shown to improve renal function. However, landmark CRT trials excluded patients with severe renal dysfunction. Therefore, this study evaluated the effect of CRT on renal function and long-term prognosis in patients with stage 4 CKD.Design, setting, participants, & measurements This study evaluated 73 consecutive CRT patients (71610 years) with stage 4 CKD who underwent echocardiographic and renal function evaluation at baseline and 6-month follow-up between 2000 and 2012. As a control group, 18 patients with stage 4 CKD who received an implantable cardioverter defibrillator (ICD) were selected. CRT recipients with $15% reduction in left ventricular end-systolic volume at 6-month follow-up were classified as CRT responders. During long-term follow-up (median, 33 months), appropriate defibrillator therapy, heart failure hospitalizations, and all-cause mortality (combined end point) were recorded.Results At 6-month follow-up, a significant reduction in left ventricular end-systolic volume was observed in CRT patients compared with patients with ICD (from 159678 to 145678 ml in CRT patients and from 126654 to 119649 ml in ICD patients; P=0.05), and CRT response was observed in 22 patients (30%). Compared with ICD patients, eGFR improved among CRT patients (from 2564 to 3069 ml/min per 1.73 m 2 ; interaction time and group, P=0.04) and was more pronounced among CRT responders (2563 to 3469 ml/min per 1.73 m 2 ; P,0.001). The combined end point was observed in 17 ICD and 62 CRT patients. CRT patients showed superior survival compared with ICD patients (log-rank P=0.03). More importantly, CRT response was independently associated with improved survival free from the combined end point (hazard ratio, 0.51; 95% confidence interval, 0.27 to 0.98; P=0.04) after adjustment for clinical and echocardiographic parameters.Conclusions Response to CRT occurs in approximately 30% of patients with stage 4 CKD, which is less than in the average CRT population. CRT was associated with better clinical outcome, and particularly, CRT response was associated with improvement in eGFR and better long-term prognosis.

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Cardiac Resynchronization Therapy in CKD

Cited by 32 publications

References 44 publications

Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

Cardiorenal syndrome: review of our current understanding

Cardiac Resynchronization Therapy in CKD Stage 4 Patients

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