Abstract 14941: Incidence of Cardiac Implantable Electronic Device Infections in End-Stage Kidney Disease Patients on Dialysis

Abstract

Introduction: Hemodialysis potentially increases the risk of cardiac implantable electronic device (CIED) infection due to transient bacteremia. There is limited available data on the incidence of CIED infections in patients with end-stage kidney disease (ESKD) on hemodialysis. The objective of this research was to study the 1-year incidence of device infection after a new CIED implant in hemodialysis patients. Methods: We conducted a retrospective observational analysis using the United States Renal Data System database. We identified patients aged >18 years with ESKD on hemodialysis who underwent first CIED implant between January 2006 and September 2014. ICD-9 codes were used and we excluded patients with a prosthetic valve. The primary outcome of the study was 1-year incidence of CIED infection. We analyzed the association of device infection with the type of CIED. Results: During the study period, a total of 46,209 patients with ESKD on dialysis received a CIED. After applying the exclusion criteria, 15,077 patients were included in the study. The mean age of the population was 69.9 years; majority were male (56.8%) and white patients (68.5%). Common comorbidities included hypertension (97.7%), dysrhythmia (75.7%), diabetes mellitus (71.1%), and congestive heart failure (67.7%). Of the included patients, 66.5% received a pacemaker (PPM), 33.1% received an implantable cardioverter-defibrillator (ICD), and 0.4% received cardiac resynchronization therapy (CRT-P or CRT-D). The overall 1-year incidence of CIED infection was 3.1%. The incidence of CIED infection was highest among patients with ICDs (4.2%), followed by CRT (3.7%), and PPM (2.5%) (p<0.0001). Conclusions: The 1-year incidence of CIED infections in ESKD patients on hemodialysis was 3.1%, which is significantly higher than the incidence reported in the general population. The highest incidence was observed in those with ICDs. These findings underscore the importance of monitoring and managing CIED infections in this population to improve patient outcomes.