Key result
Cardiac resynchronization therapy stabilized renal function in heart failure patients and yielded a 54% short-term and 65% long-term echocardiographic response rate.
Why the study?
Does Cardiac resynchronization therapy (CRT) prevent the progression of renal failure and improve mortality in heart failure patients?
Cohort (n=588)
No
Does Cardiac resynchronization therapy (CRT) prevent the progression of renal failure and improve mortality in heart failure patients?
In patients with heart failure, CRT implantation is associated with the stabilization of renal function and significant improvement in those with advanced CKD, which independently predicts lower mortality.
Hypothesis-generating for renal effects of CRT in HF; requires randomized trials before clinical adoption.
BACKGROUND: The goal of this study is to assess the effect of cardiac resynchronization therapy (CRT) over time on renal function and its impact on mortality. The effect of CRT on renal function in patients with heart failure is not well understood. METHODS: All patients who underwent CRT implantation at University of Kansas between year 2000 and 2009 were reviewed and patients who had pre and post CRT renal function studied were included in our study. Stages of chronic kidney disease (CKD) were defined based on Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. The effect of CRT on renal and cardiac function were studied at short term (≤6 months post implantation) and long term (>6 months). RESULTS: A total of 588 patients with mean age of 67 ± 12 yrs were included in the study. CRT responders (defined by increase in LVEF ≥ 5%) were 54% during short term follow-up and 65% on long term follow-up. When compared to baseline, there was no significant deterioration in mean Glomerular Filtration Rate (GFR) during follow up. When analyzed based on the stages of CKD, there was significant improvement of renal function in patients with advanced kidney disease. Multivariate logistic regression analysis showed that stable GFR or an improvement in GFR independently predicted mortality after adjusting for co-morbidities. CONCLUSIONS: CRT was associated with stabilization of renal function in patients with severe LV dysfunction and improvement in stage 4 and 5 CKD. Improved renal function was associated with a lower mortality.
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Jeevanantham et al. (2016) conducted a cohort in Heart failure (n=588). Cardiac resynchronization therapy vs. Baseline was evaluated on Change in renal function (GFR) and mortality. Cardiac resynchronization therapy stabilized renal function in heart failure patients and yielded a 54% short-term and 65% long-term echocardiographic response rate.
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