End-Stage Renal Disease Predicts Complications in Pacemaker and ICD Implants

Tompkins, Christine; McLean, Rhondalyn C.; Cheng, Alan; Brinker, Jeffrey A.; Marine, Joseph E.; Nazarian, Saman; Spragg, David D.; Sinha, Sunil K.; Halperin, Henry R.; Tomaselli, Gordon F.; Berger, Ronald D.; Calkins, Hugh; Henrikson, M.P.H. Charles A.

doi:10.1111/j.1540-8167.2011.02066.x

Cited by 107 publications

(92 citation statements)

References 41 publications

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“…In our present study, clinical characteristics specific to our HD patients were pacemaker implantation is predicted after weaning from cardiopulmonary bypass (CPB), epicardial permanent pacing wires (atrial and ventricular) should be implanted intra-operatively, because a permanent intravascular device is a potential risk for recurrent IE in HD patients. 9) The generator would be implanted after the operation when the infection is controlled and the IE is considered to be healed in order to prevent electrical device infection.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis

Omoto

Aoki

Maruta

et al. 2016

ATCS

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IntroductionInfective endocarditis (IE) occurs 18 times more frequently in chronic hemodialysis (HD) patients than in the general population. 1) Several previous studies have demonstrated high postoperative mortality (11%-80%) in HD patients who require surgical intervention for IE, [2][3][4] however, little information is available on the preoperative management of these patients.Here, to improve preoperative management in HD patients requiring surgical intervention for IE, we reviewed surgical experience at our institution over a 10-year period to elucidate the characteristics of chronic HD patients requiring surgery during the active phase of IE. We also reviewed long-term outcomes in these HD patients. Materials and MethodsThis study was approved by the institutional review board of Showa University, School of Medicine, and informed consent was obtained from all patients. We reviewed the cases of all patients undergoing surgery on native valves for active IE in our institute between December 2004 and July 2015. The surgical strategy in our institute remained consistent over that time period. Redo operations were excluded from the study.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis

Omoto

Aoki

Maruta

et al. 2016

ATCS

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“…Renal disease, and in particular end-stage kidney failure requiring dialysis, has been associated with higher mortality rates and infections in patients with pacemakers and ICDs. [12][13][14] The risk of excess mortality becomes evident at even a moderate level of renal dysfunction (<60 mL/min/1.73 m 2 ). 12 In our current prospective study, we found CKD to be a strong risk factor for mortality.…”

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confidence: 99%

REPLACE DARE (Death After Replacement Evaluation) Score

Chung

Holcomb

Mittal

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Few studies have evaluated mortality and associated risk factors following CIED replacement or upgrade procedures. Advanced age, comorbid conditions, and procedure-related complications might contribute to mortality. The REPLACE Registry, a prospective multicenter study that evaluated patients undergoing device replacement with or without planned lead addition or revision, provided a unique opportunity to examine this question. 2 The objectives of the current © 2014 American Heart Association, Inc. Original ArticleBackground-Identifying factors predictive of mortality may be important to decrease risk associated with cardiac implantable electrical device (CIED) replacement procedures. This study aimed to determine whether clinical factors and complications independently associate with death and to develop a mortality risk prediction tool after CIED replacement. Methods and Results-The prospective REPLACE Registry determined 6-month complication and mortality rates after CIED replacement with or without planned lead addition or revision. Vital status was collected. Kaplan-Meier survival and multivariable Cox proportional hazards regression analyses were performed to identify patient, procedural, or complication variables predictive of death. The REPLACE DARE (Death After Replacement Evaluation) Score was constructed using hazard ratios, reflecting relative risk contributions of each variable, combined into an additive mortality risk score equation. At 6 months, 70 of 1744 (4.0%) patients had died. Cox regression analysis found no significant association between major complications and death. However, recent heart failure admission, New York Heart Association class III/IV, antiarrhythmic drug use, cerebrovascular disease, and chronic kidney disease stage were independently associated with 6-month mortality. The REPLACE DARE Score was 2.0±1.4 in survivors versus 3.5±1.8 in nonsurvivors (P<0.001), with predictive receiver operating characteristic value=0.758 (P<0.001). Risk of death was 1.0% for DARE=0 and 55.6% for DARE=7. The hazard ratio was 1.8 for each change of 1 DARE unit. Conclusions-Comorbidities, but not complications, were significantly associated with mortality after CIED replacement.The REPLACE DARE Score is a novel tool that can identify patients with substantial mortality risk. Such patients should have the relative risk and benefit of their procedure considered carefully. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00395447.

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“…47) Compared with controls, dialysis patients have markedly increased bleeding and device-related infections (12.5% versus 0.2%, P < 0.00001). 48) In light of this information, the high incidence of complications may offset the potential survival benefit of ICD implantation in patients with stage 5 CKD. Finally, the presence of comorbidities such as atrial fibrillation, wide QRS, older age, and severe heart failure may counteract the benefit of ICD implantation in dialysis patients.…”

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confidence: 99%

Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages?

Zhou

Zhu

et al. 2017

Int. Heart J.

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SummaryThe benefits of implantable cardioverter defibrillator (ICD) implantation in chronic kidney disease (CKD) patients with high sudden cardiac death (SCD) risk are uncertain. To clarify the effects of receiving an ICD in CKD patients, we conducted this meta-analysis to identify the effects of ICDs on patients with CKD, including those on dialysis. We searched the Cochrane library, EMBASE, PubMed, and clinical trials for studies published before July 2016. Eleven studies including 20,196 CKD patients were considered for inclusion. The pooled analysis suggested that patients with an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m 2 would benefit from receiving treatments with ICDs compared with patients without an ICD device (aHR = 0.77; 95% confidence interval [CI], 0.63 to 0.95). This is the first report of a subgroup analysis on the survival rate of ICD implantation in CKD patients according to an eGFR group. The subgroup analysis indicated a similar protective association of ICDs in stage 3 CKD patients (aHR = 0.71; 95%CI, 0.61 to 0.82) compared with the control group. However, there was no significant improvement in all-cause mortality in stage 4 CKD patients (aHR = 1.02; 95%CI, 0.75 to 1.37) or stage 5 CKD patients (aHR = 0.80; 95%CI, 0.60 to 1.31). This is the first meta-analysis reporting that ICD implantation reduces all-cause mortality in stage 3 CKD patients. However, the data do not indicate there is any benefit to ICD implantation in stage 4 or 5 CKD patients. (Int Heart J 2017; 58: 371-377)

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End-Stage Renal Disease Predicts Complications in Pacemaker and ICD Implants

Abstract: ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.

Cited by 107 publications

References 41 publications

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis

REPLACE DARE (Death After Replacement Evaluation) Score

Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages?

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