Key result
Ipsilateral placement of a cardiac implantable electronic device and vascular access was associated with a significantly higher incidence of the primary composite outcome compared to contralateral placement (73% vs 40%, P=0.03).
Why the study?
Does ipsilateral CIED and vascular access placement increase mortality or systemic complications compared to contralateral placement in chronic hemodialysis patients?
Cohort (n=42)
No
Does ipsilateral CIED and vascular access placement increase mortality or systemic complications compared to contralateral placement in chronic hemodialysis patients?
Absolute Event Rate: 73% vs 40%
p-value: p=0.03
In chronic hemodialysis patients, ipsilateral placement of a CIED and vascular access is associated with a significantly higher incidence of systemic complications compared to contralateral placement, supporting the recommendation to avoid ipsilateral placement when feasible.
Ipsilateral placement was associated with more complications in hemodialysis; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: We investigated the impact of a transvenous cardiac implantable electronic device (CIED) placement on outcomes and arteriovenous vascular access (VA) patency among chronic hemodialysis patients. METHODS: This is a single-center, observational comparative study between chronic hemodialysis patients with ipsilateral and contralateral CIED and VA. Forty-two consecutive patients who underwent both CIED placement and upper-extremity VA for hemodialysis, regardless of the sequence and time interval between these 2 procedures, were identified between January 2001 and December 2017. Patients with ipsilateral (n = 22, 52%, the ipsilateral group) and contralateral (n = 20, 48%, the contralateral group) CIED and VA were compared retrospectively; the primary outcome was any-cause mortality and cardiac mortality or the composite of any systemic complications, defined as central venous stenosis or occlusion, any device infections or tricuspid regurgitation; the secondary outcome was CIED or VA malfunction. RESULTS: During the median follow-up period of 101 months, primary outcome incidence was significantly higher in the ipsilateral group than the contralateral group (73% vs 40%, P = 0.03), although the incidences of any-cause mortality (P = 0.28) and cardiac mortality (P > 0.99) were similar between the groups. Secondary outcome incidence did not differ significantly between the 2 groups (55% vs 30%, P = 0.36). Kaplan-Meier survival analysis revealed similar primary and secondary VA patency rates in both groups. On subgroup analysis, patients with upper arm VA had similar primary and secondary patency to those with forearm VA. CONCLUSIONS: Despite some notable limitations of the study, the retrospective study design and small sample size, we found that the any-cause mortality incidence and VA patency did not differ between the 2 groups, but primary outcome incidence was significantly higher among patients with ipsilateral CIED and VA.
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Jeong et al. (2018) conducted a cohort in Chronic hemodialysis (n=42). Ipsilateral CIED and VA placement vs. Contralateral CIED and VA placement was evaluated on Composite of any-cause mortality, cardiac mortality, or any systemic complications (central venous stenosis or occlusion, device infections, or tricuspid regurgitation) (p=0.03). Ipsilateral placement of a cardiac implantable electronic device and vascular access was associated with a significantly higher incidence of the primary composite outcome compared to contralateral placement (73% vs 40%, P=0.03).
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