#3001 PREVALENCE OF IMPLANTABLE CARDIAC DEVICES IN A COHORT OF PATIENTS WITH CHRONIC KIDNEY FAILURE: A MULTICENTER CROSS-SECTIONAL STUDY

Abstract

Abstract Background and Aims Chronic kidney disease (CKD) increases the risk of arrhythmic events and sudden cardiac death. For preventive purposes, the use of cardiac implantable electronic devices (CIEDs), including pacemakers (PMs), implantable cardiac defibrillators (ICDs), pacemakers for cardiac resynchronization therapy (CRTs), and loop recorders, can be used. However, in the absence of large epidemiological studies, whether the use of CIEDs in hemodialysis patients is associated with a lower mortality benefit than in pre-dialysis patients remains controversial. In this cross-sectional study, we evaluate the prevalence of CIEDs in a cohort of patients with CKD. Method The study includes patients with CIEDs with estimated GFR <45 ml/min/1.73 m2 from two hospitals in Milan, divided into two groups based on treatment with conservative therapy (IRC stage IIIb-V) or hemodialysis. Results Of the 499 patients enrolled, 268 had CKD stage IIIb-V, and 231 were in hemodialysis (Table 1). Among CRT carriers, the prevalence in the CKD IIIb-V group is significantly higher than in the hemodialysis group (4.09% vs 0.86%; p = 0.025) (Figure 1), even if among the hemodialysis patients the prevalence of patients with previous stroke and hypertension was significantly higher (Table 1). Furthermore, in multiple logistic regressions, hemodialysis was a variable independently correlated with reduced use of CRTs (OR 0.27; 95% CI = 0.01-0.96; p 0.04), while the other devices (individually and cumulatively) correlated positively only with age and previous myocardial infarction (MI) (Table 2). Conclusion The reduced prevalence of CRT in hemodialysis patients is probably related to the shorter life expectancy and the higher rate of related complications, such as the increased risk of infectious complications and/or stenosis of the central venous vessels. Further studies are needed to evaluate the impact of these devices on the cardiac mortality of hemodialysis patients and the associated complication rate.