Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States

Muhammad Zia Khan; Amanda Nguyen; Muhammad Usman Khan; Yasar Sattar; Waleed Alruwaili; Karthik Gonuguntla; Hafiz Muhammad Sohaib Hayat; Melody Mendez; Sameh Nassar; Zain Ul Abideen Asad; Siddharth Agarwal; Sameer Raina; Sudarshan Balla; Bao Nguyen; Dali Fan; Douglas Darden; Muhammad Bilal Munir

doi:10.1016/j.hrthm.2024.03.1816

Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States

Heart Rhythm. 2024 Apr 2:S1547-5271(24)02311-7. doi: 10.1016/j.hrthm.2024.03.1816. Online ahead of print.

Authors

Muhammad Zia Khan¹, Amanda Nguyen², Muhammad Usman Khan³, Yasar Sattar¹, Waleed Alruwaili¹, Karthik Gonuguntla¹, Hafiz Muhammad Sohaib Hayat⁴, Melody Mendez⁴, Sameh Nassar¹, Zain Ul Abideen Asad⁵, Siddharth Agarwal⁵, Sameer Raina⁶, Sudarshan Balla¹, Bao Nguyen⁴, Dali Fan⁴, Douglas Darden⁷, Muhammad Bilal Munir⁸

Affiliations

¹ Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
² Department of Medicine, University of California Davis Medical Center, Sacramento, California.
³ University of Florida, Jacksonville, Florida.
⁴ Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California.
⁵ Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma.
⁶ Division of Cardiology, Stanford University, Stanford, California.
⁷ Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas.
⁸ Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California. Electronic address: mbmunir@ucdavis.edu.

PMID: 38574789
DOI: 10.1016/j.hrthm.2024.03.1816

Abstract

Background: Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited.

Objective: The objective of this study was to evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations.

Methods: National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with CKD and ESRD who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study end points assessed included inpatient complications, outcomes, and resource utilization of leadless pacemaker implantations.

Results: A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n = 5245 [18.1%]) and ESRD (n = 3790 [13.1%]) were younger than patients without CKD and had higher prevalence of important comorbidities. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (CKD: adjusted odds ratio [aOR], 1.62 [95% CI, 1.40-1.86]; ESRD: aOR, 1.38 [95% CI, 1.18-1.63]) and prolonged length of stay (CKD: aOR, 1.55 [95% CI, 1.46-1.66]; ESRD: aOR, 1.81 [95% CI 1.67-1.96]). ESRD was also associated with higher hospitalization costs (aOR, 1.63; 95% CI, 1.50-1.77) and major complications (aOR, 1.33; 95% CI, 1.13-1.57) after leadless pacemaker implantation.

Conclusion: Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay and inpatient mortality.

Keywords: Chronic kidney disease; Complications; End-stage renal disease; Leadless pacemaker; Outcomes.