Key result
Cardiac devices benefit early CKD but carry sharply higher mortality and infection risks in advanced disease.
Why the study?
CKD increases arrhythmia burden and cardiovascular risk while influencing device decisions, yet data on cardiac device therapy in CKD patients remain scarce.
Does cardiac device therapy (CRT, ICD, LVAD, pacemakers) improve outcomes in patients with chronic kidney disease compared to general populations or standard therapy?
Does cardiac device therapy (CRT, ICD, LVAD, pacemakers) improve outcomes in patients with chronic kidney disease compared to general populations or standard therapy?
Cardiac device therapy decisions require personalized, shared decision-making in CKD patients, as clinical benefits attenuate while mortality and infection risks rise exponentially in advanced renal failure.
Personalized device decisions remain essential in CKD; leaves open need for RCTs in advanced stages.
Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are frequently interconnected and their association leads to an exponential increase in the risk of both fatal and non-fatal events. In addition, the burden of arrhythmias in CKD patients is increased. On the other hand, the presence of CKD is an important factor that influences the decision to pursue cardiac device therapy. Data on CKD patients with device therapy are scarce and mostly derives from observational studies and case reports. Cardiac resynchronization therapy (CRT) is associated with decreased mortality, reduced heart failure symptoms, and improved renal function in early stages of CKD. Implantable cardioverter defibrillators (ICDs) are associated with a significant reduction in the mortality of CKD patients only for the secondary prevention of sudden cardiac death. Cardiac resynchronization therapy with defibrillator (CRT-D) is preferred in patients who meet the established criteria. The need for cardiac pacing is increased three-fold in dialysis patients. CKD is an independent risk factor for infections associated with cardiac devices.
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Caba et al. (2024) conducted a review in Chronic Kidney Disease and Heart Failure. Cardiac device therapy (CRT, ICD, LVAD, Pacemakers) was evaluated. Cardiac device therapies offer benefits in early chronic kidney disease, but mortality and infection risks markedly increase in advanced stages and end-stage renal disease.
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