Key result
Inpatient ICD placement in patients with ESRD was associated with higher odds of postoperative hemorrhage (OR 1.67; 95% CI 1.4-1.99) and in-hospital mortality (OR 4.56) versus normal renal function.
Why the study?
Real-world data on in-hospital complications following ICD therapy in patients with ESRD were limited.
Does end stage renal disease increase the risk of in-hospital complications following implantable cardioverter-defibrillator placement compared to normal renal function?
Cohort (n=40,075)
Yes
Does end stage renal disease increase the risk of in-hospital complications following implantable cardioverter-defibrillator placement compared to normal renal function?
Patients with end stage renal disease undergoing inpatient ICD placement face significantly higher risks of procedural complications and in-hospital mortality compared to patients with normal renal function.
Supports heightened caution for inpatient ICDs in ESRD; leaves open causal inference and optimal selection.
BACKGROUND: When compared to patients with normal renal function, patients with chronic kidney disease develop higher in-hospital complications post implantable cardioverter-defibrillator (ICD) therapy. However, real world data on in-hospital complications post ICD therapy in patients with end stage renal disease (ESRD) is limited. In this study, we aim to explore the procedure-related complications of ICD therapy in patients with ESRD. METHODS: Using the nationwide inpatient sample (NIS) database, we conducted a retrospective analysis on ESRD patients who underwent inpatient ICD placement from 2010 to 2016. Using 1:2 propensity score matching, we compared ESRD patients to those with normal renal function. Outcomes of interest were postoperative hemorrhage and hematoma formation, blood transfusion, pericardial complications, mechanical complications requiring lead revision, vascular injury, in-hospital mortality, and length of stay. RESULTS: Our sample included 40,075 cases with subsequent propensity score matching between ESRD and normal renal function. Comparatively, patients with ESRD had higher odds of postoperative hemorrhage (Odds ratio [OR] = 1.67, 95% confidence interval [CI] 1.4-1.99, p = < .0001), blood transfusion (OR, 3.88; CI 3.29-4.56; p = < .0001), mechanical complications requiring lead revision (OR, 1.24; CI 1.01-1.51; p = .035), vascular injury (OR, 2.02; CI 1.27-3.24; p = .0027), in-hospital mortality (OR, 4.56; CI 3.08-6.76; p = < .0001), and longer hospitalization (11 vs. 7 days, p = < .0001), but without significant difference in pericardial complications (OR, 1.9; CI 0.92-1.54; p = < .18). CONCLUSION: In this large contemporary cohort, patients with ESRD undergoing inpatient ICD therapy are at higher risk of developing postprocedural complications including hemorrhage and hematoma, blood transfusion, mechanical complications requiring lead revision, and in hospital mortality, without increased risk of pericardial complications.
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Ayoub et al. (2021) conducted a cohort in End stage renal disease requiring implantable cardioverter-defibrillator (n=40,075). Inpatient ICD placement vs. Patients with normal renal function was evaluated on Postoperative hemorrhage (OR 1.67, 95% CI 1.4-1.99, p=< .0001). Inpatient ICD placement in patients with ESRD was associated with higher odds of postoperative hemorrhage (OR 1.67; 95% CI 1.4-1.99) and in-hospital mortality (OR 4.56) versus normal renal function.
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