Key result
Cardiac device therapy, including CRT and ICDs, is associated with decreased mortality in selected patients with chronic kidney disease, though CKD is an independent risk factor for infections.
Why the study?
CKD increases arrhythmia burden and influences cardiac device decisions, but data on CKD patients receiving device therapy are scarce and mostly limited to observational studies and case reports.
Does cardiac device therapy improve clinical outcomes and what are the associated risks in patients with chronic kidney disease?
Does cardiac device therapy improve clinical outcomes and what are the associated risks in patients with chronic kidney disease?
Cardiac device therapy provides mortality and symptomatic benefits in selected CKD patients, but is complicated by a higher risk of device-related infections and increased pacing needs in dialysis patients.
Limited evidence on device therapy in CKD advises caution in decisions; leaves open the need for prospective trials on outcomes.
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 is 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 defibrillator (CRT-D) is preferred in patients that meet the established criteria. The need for cardiac pacing is 3-fold higher in dialysis patients. CKD is an independent risk factor for infections associated with cardiac devices.
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Caba et al. (2023) conducted a review in Chronic Kidney Disease. Cardiac Device Therapy was evaluated. Cardiac device therapy, including CRT and ICDs, is associated with decreased mortality in selected patients with chronic kidney disease, though CKD is an independent risk factor for infections.
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