Trends in the Use and Complications of Cardiac Resynchronization Therapy Device Implantation in Chronic Kidney Disease Patients

Asim Kichloo; Dhanshree Solanki; Ronald Berger; Shakeel Jamal; Michael Albosta; Michael Aljadah; Muhammad Zia Khan; Khalil Kanjwal

doi:10.19102/icrm.2023.14023

Trends in the Use and Complications of Cardiac Resynchronization Therapy Device Implantation in Chronic Kidney Disease Patients

J Innov Card Rhythm Manag. 2023 Feb 15;14(2):5339-5347. doi: 10.19102/icrm.2023.14023. eCollection 2023 Feb.

Authors

Asim Kichloo^{1

2}, Dhanshree Solanki³, Ronald Berger⁴, Shakeel Jamal¹, Michael Albosta⁵, Michael Aljadah⁶, Muhammad Zia Khan⁷, Khalil Kanjwal⁸

Affiliations

¹ Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.
² Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA.
³ Department of Health Administration, Rutgers University, New Brunswick, NJ, USA.
⁴ Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Internal Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.
⁶ Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
⁷ Department of Internal Medicine, West Virginia University, Morgantown, WV, USA.
⁸ Section of Electrophysiology, Michigan State University, McLaren Greater Lansing Hospital, Lansing, MI, USA.

Abstract

Large-scale multi-hospital data on cardiac resynchronization therapy (CRT) device implantation in patients with chronic kidney disease (CKD) are currently lacking. The purpose of this study was to examine the incidence of CRT device implantation in patients hospitalized with CKD and the impact of CRT device implantation on hospital complications and outcomes. We analyzed the Nationwide Inpatient Sample from 2008-2014 to identify yearly trends in CRT device implantation during CKD hospitalizations. We compared CRT biventricular pacemakers (CRT-Ps) and CRT defibrillators (CRT-Ds). We also obtained rates of comorbidities and complications associated with CRT device implantations. From 2008-2014, the proportion of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-P devices consistently went up from 2008 to 2014 (from 12.3% to 23.8%, P < .0001) compared to the number of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-D devices, which showed a consistent downward trend (from 87.7% to 76.2%, P < .0001). During CKD hospitalizations, most CRT device implantations were performed in patients aged 65-84 years (68.6%) and in men (74.3%). The most common complication of CRT device implantation during hospitalizations involving CKD was hemorrhage or hematoma (2.7%). Patients hospitalized with CKD who developed any complication associated with CRT device implantation had 3.35-fold increased odds of mortality compared to those without complications (odds ratio, 3.35; 95% confidence interval, 2.18-5.16; P < .0001). In summary, this study shows that CRT-P implantations became more common in CKD patients, while the rate of CRT-D implantations decreased over time. Hemorrhage or hematoma was the most common complication (2.7%), and the mortality risk was increased by 3.35 times in patients who developed periprocedural complications.

Keywords: Cardiac resynchronization therapy; chronic kidney disease; defibrillator; pacemaker.