Outcomes of ICDs and CRTs in patients with chronic kidney disease: a meta-analysis of 21,000 patients

Shurrab, Mohammed; Ko, Dennis T.; Zayed, Yazan; Navaneethan, Sankar D.; Yadak, Nour; Yaseen, Abeer; Kaoutskaia, Anna; Qamhia, Waad; Hamdan, Zakaria; Haj‐Yahia, Saleem; Lee, Douglas S.; Newman, David; Healey, Jeff S.; Harvey, P. R. C.; Crystal, Eugene

doi:10.1007/s10840-018-0424-1

Cited by 9 publications

(12 citation statements)

References 60 publications

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“…From a large meta-analysis of published studies, it is known that the use of CRT in patients with CKD positively affects patient survival; however, the mechanism by which this occurs is unknown. e authors of our study strongly recommend that a randomized controlled trial should be conducted to define the role of CRT implantation in patients with CKD [10]. Despite some interesting observations and results, in our opinion, the current research work has its limitations.…”

Section: Variablementioning

confidence: 84%

“…Resynchronization therapy (CRT) is a well-established treatment for patients with clinically apparent heart failure, decreased left ventricular ejection fraction (LVEF), and prolonged QRS duration on surface electrocardiogram (ECG) [9]. It is also known that CRT implantation reduces mortality in the CKD population overall [10]. Also, patients with renal dysfunction are poorly represented in CRT clinical trials, which results in a lack of evidence to guide treatment in this high-risk group [11].…”

Section: Introductionmentioning

confidence: 99%

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Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Gala-Błądzińska

Romanek

Mazur

et al. 2020

Cardiology Research and Practice

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Background. Patients with chronic cardiorenal syndrome type 2 (T2-CRS) who qualify for resynchronization therapy (CRT) are exposed perioperatively to potentially nephrotoxic factors including contrast agents and blood loss. Methods. The objective of this prospective interventional study was to assess the effects of CRT on renal function in patients with T2-CRS within the first 48 hours following implantation. Initially, 76 patients (15% female; aged 69 ± 9.56 years) with heart failure (New York Heart Association classes II–IV), ejection fraction ≤ 35%, and QRS > 130 ms were included in the study. During CRT implantation, a nonionic contrast agent (72.2 ± 44.9 mL) was administered. Prior to and 48 hours following implantation, renal function was evaluated using the following serum biomarkers: creatinine (sCr), estimated glomerular filtration rate (using the Chronic Kidney Disease Epidemiology Collaboration equation [eGFRCKD-EPI]), and the electrolyte and urine biomarkers albumin (uAlb), albumin/creatinine ratio (UACR), and neutrophil gelatinase-associated lipocalin (uNGAL). Results. Before CRT, patients classified as NYHA class III or IV had higher uNGAL levels in comparison to uNGAL levels after CRT (43.63 ± 60.02 versus 16.63 ± 18.19; p=0.041). After CRT implantation, uAlb, UACR, and potassium levels were reduced (p<0.05), and uNGAL, sCr, and eGFRCKD-EPI were unchanged. The contrast medium volume did not correlate with the test biomarkers (p>0.05). Conclusions. In patients with T2-CRS, uNGAL is a biomarker of kidney injury that correlates with the NYHA classes. A stable uNGAL value before and after CRT implantation confirms the lack of risk of contrast-induced nephropathy. Reduced albuminuria and blood potassium are biomarkers of improving T2-CRS in the early post-CRT period.

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Section: Variablementioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Gala-Błądzińska

Romanek

Mazur

et al. 2020

Cardiology Research and Practice

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“…Thus it further demonstrates that CRT(D) could improve survival prognosis in comparison with ICD in CKD patients. Similarly, a meta‐analysis of 21,000 patients showed that compared with ICD, patients with CRT have a lower risk of all‐cause death (OR = 0.73; 95% CI, 0.57 to 0.92; p = 0.01) 43 . Compared with ICD, CRT(D) is more consistent with physiological pacing.…”

Section: Discussionmentioning

confidence: 98%

Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta‐analysis

Liu

Sun

Zhu

et al. 2020

Seminars in Dialysis

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Renal insufficiency and heart disease are two challenging conditions for the current health-care system. More than 660,000 Americans suffer from end-stage kidney disease (ESKD) and have reached the point of intervention, with 468,000 receiving dialysis therapy. 1 Moreover, in a Duke Electrophysiology Genetic and Genomic Studies (EPGEN) study, estimated glomerular filtration rate (eGFR) decreased by 10 ml/min/1.73 m 2 and mortality increased by 48% (p < 0.001) 2 and major cardiac events account for nearly 50% of deaths in patients with chronic kidney disease (CKD). 3 Renal insufficiency is a common complication of cardiovascular diseases and is a strong independent risk factor for mortality. 4 CKD has been reported in up to 40% of chronic heart failure patients. 5 Moreover, progressive heart failure can lead to renal hypoperfusion and activation of inflammatory factors, and further result in the deterioration of renal function. 5 Similarly, arrhythmia is also a common cause of death in dialysis patients, accounting for 26% and 25% of hemodialysis and peritoneal dialysis deaths respectively. 6 Cardiac resynchronization therapy (CRT) can improve clinical symptoms and left ventricular ejection fraction (LVEF) and reduce

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“…Moreover, patients with ESKD receiving ICDs have a significantly increased risk of developing procedure-related complications [21]. On the other hand, in some studies, a potentially beneficial effect of ICDs in this patient population was described [22][23][24].…”

Section: Cied Evidence In Ckd Patientsmentioning

confidence: 99%

“…Thankfully, cardiac resynchronization therapy (CRT) outcomes in patients with systolic heart failure and CKD are clearly more positive, despite a more complex implantation procedure [24][25][26]. Effective left ventricle reverse remodeling plays a vital role in preserving renal function, regardless of the degree of baseline renal insufficiency [27].…”

Section: Cied Evidence In Ckd Patientsmentioning

confidence: 99%

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

Nowak

Kusztal

2021

JCM

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Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.

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Outcomes of ICDs and CRTs in patients with chronic kidney disease: a meta-analysis of 21,000 patients

Cited by 9 publications

References 60 publications

Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta‐analysis

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

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