Key result
Among elderly patients undergoing CRT implantation, 20% developed AKI, which was significantly predicted by prior renal insufficiency (OR 15.4), bleeding (OR 7.86), and intra-operative hypotension.
Why the study?
Data on acute kidney injury (AKI) post cardiac resynchronization therapy (CRT) implantation is limited, especially in the elderly, and non-contrast risk factors remain unclear.
What are the clinical risk factors for acute kidney injury following cardiac resynchronization therapy implantation in an elderly population?
Observational (n=60)
No
What are the clinical risk factors for acute kidney injury following cardiac resynchronization therapy implantation in an elderly population?
AKI is a frequent complication of CRT implantation in the elderly, driven by clinical factors such as prior renal insufficiency, hypotension, and bleeding, and is associated with significantly prolonged hospital stay.
May inform pre-CRT risk assessment in elderly patients; leaves open whether modifying predictors reduces AKI incidence.
BACKGROUND: Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI. OBJECTIVES: To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality. METHODS: Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center. RESULTS: 60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI). CONCLUSIONS: AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.
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Marschall et al. (2020) conducted an observational in Cardiac resynchronization therapy (CRT) implantation (n=60). Patient and procedure-related risk factors was evaluated on Occurrence of acute kidney injury (AKI) post CRT. Among elderly patients undergoing CRT implantation, 20% developed AKI, which was significantly predicted by prior renal insufficiency (OR 15.4), bleeding (OR 7.86), and intra-operative hypotension.
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