ESRD and Complications in Pacemaker and ICD Implants
ESRD and Complications in Pacemaker and ICD Implants
End-Stage Renal Disease Predicts Complications in Pacemaker and ICD Implants.
Introduction: Patients with chronic kidney disease (CKD) have increased morbidity following invasive procedures. We hypothesized that patients with CKD have higher complication rates following device implantation than patients with normal renal function.
Methods:We reviewed the medical records of patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. The estimated glomerular filtration rate (GFR) was calculated using the Cockroft–Gault equation. Those with GFR ≥ 90 cc/min served as controls. The remainder was grouped according to American Kidney Foundation stages of CKD. Bleeding complications were defined as need for pocket exploration or blood transfusion; cardiac tamponade; or hematoma requiring pressure dressing, change in medications or prolonged hospitalization. Infection was defined as infection of the pocket or lead system, or development of bacteremia/sepsis within 60 days.
Results: There were 82 bleeding complications (5.7%) and 7 infections (0.5%) temporally related to device implantation in 1,440 patients. End-stage renal disease (ESRD), defined as GFR < 15 mL/min or need for dialysis, was identified in 32 patients. Infection rates were significantly higher in patients with ESRD versus controls (12.5% vs 0.2%; P < 0.0001). A significant increase in bleeding complications was observed in ESRD versus controls (21.9% vs 3.2%, respectively; P<0.0001). Bleeding complications were considerably greater than controls in moderate (GFR 30–59 mL/min) and severe (GFR 15–29 mL/min) CKD (7.4% and 9.8% vs 3.2%, respectively; P < 0.005).
Conclusion: ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.(J Cardiovasc Electrophysiol, Vol. 22, pp. 1099–1104, October 2011)
Patients with acute or chronic renal insufficiency have increased morbidity and mortality following invasive procedures. Even mild renal insufficiency has been associated with increased rates of in-hospital mortality, need for dialysis and postoperative stroke in patients undergoing coronary artery by pass grafting. Retrospective studies suggest that patients with chronic kidney disease (CKD) are also at increased risk of developing cardiac device (pacemaker and implantable cardioverter-defibrillator)-related infections requiring system extraction. Whether factors unique to CKD contribute to these outcomes or merely identify a high-risk patient population remains unclear.
Randomized studies evaluating the efficacy of implanted cardiac devices generally exclude patients with end-stage renal disease (ESRD). However, many patients with ESRD have concomitant cardiac disease with indications for device therapy. Limited information is available assessing complications following cardiac device implantation in this potentially high-risk patient population.
The purpose of this studywas to investigate the association between renal insufficiency and procedure-related complications in patients undergoing cardiac device implantation.
We hypothesized that patients with CKD are at increased risk of developing bleeding and infection-related complications following cardiac device implantation.
Abstract and Introduction
Abstract
End-Stage Renal Disease Predicts Complications in Pacemaker and ICD Implants.
Introduction: Patients with chronic kidney disease (CKD) have increased morbidity following invasive procedures. We hypothesized that patients with CKD have higher complication rates following device implantation than patients with normal renal function.
Methods:We reviewed the medical records of patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. The estimated glomerular filtration rate (GFR) was calculated using the Cockroft–Gault equation. Those with GFR ≥ 90 cc/min served as controls. The remainder was grouped according to American Kidney Foundation stages of CKD. Bleeding complications were defined as need for pocket exploration or blood transfusion; cardiac tamponade; or hematoma requiring pressure dressing, change in medications or prolonged hospitalization. Infection was defined as infection of the pocket or lead system, or development of bacteremia/sepsis within 60 days.
Results: There were 82 bleeding complications (5.7%) and 7 infections (0.5%) temporally related to device implantation in 1,440 patients. End-stage renal disease (ESRD), defined as GFR < 15 mL/min or need for dialysis, was identified in 32 patients. Infection rates were significantly higher in patients with ESRD versus controls (12.5% vs 0.2%; P < 0.0001). A significant increase in bleeding complications was observed in ESRD versus controls (21.9% vs 3.2%, respectively; P<0.0001). Bleeding complications were considerably greater than controls in moderate (GFR 30–59 mL/min) and severe (GFR 15–29 mL/min) CKD (7.4% and 9.8% vs 3.2%, respectively; P < 0.005).
Conclusion: ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.(J Cardiovasc Electrophysiol, Vol. 22, pp. 1099–1104, October 2011)
Introduction
Patients with acute or chronic renal insufficiency have increased morbidity and mortality following invasive procedures. Even mild renal insufficiency has been associated with increased rates of in-hospital mortality, need for dialysis and postoperative stroke in patients undergoing coronary artery by pass grafting. Retrospective studies suggest that patients with chronic kidney disease (CKD) are also at increased risk of developing cardiac device (pacemaker and implantable cardioverter-defibrillator)-related infections requiring system extraction. Whether factors unique to CKD contribute to these outcomes or merely identify a high-risk patient population remains unclear.
Randomized studies evaluating the efficacy of implanted cardiac devices generally exclude patients with end-stage renal disease (ESRD). However, many patients with ESRD have concomitant cardiac disease with indications for device therapy. Limited information is available assessing complications following cardiac device implantation in this potentially high-risk patient population.
The purpose of this studywas to investigate the association between renal insufficiency and procedure-related complications in patients undergoing cardiac device implantation.
We hypothesized that patients with CKD are at increased risk of developing bleeding and infection-related complications following cardiac device implantation.
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