Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review.

Krzysztof Nowak,Mariusz Kusztal

doi:10.3390/jcm10081745

Abstract

Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.

Highlights

Published: 17 April 2021Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions
They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD)
When creating permanent vascular access, a clinical scenario may be complicated by CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm

Summary

Introduction

Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. These devices are used for the management or prevention of cardiac dysrhythmias and heart failure therapy They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). When creating permanent vascular access, a clinical scenario may be complicated by CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm This is especially true if hemodialysis is the only available modality of renal replacement therapy. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection (lead-associated endocarditis) These dangers suggest an individual approach in access creation, including additional interventions, like percutaneous venoplasty, removal and replacement of the CIED system in an alternate site, or creation of alternative arteriovenous access. Such an interchange should start even before the decision about CIED implantation in a patient with known CKD is made

CIED Evidence in CKD Patients

CIED Procedure in a CKD Patient

CIEDs in a Patient on Hemodialysis

Findings

Vascular Access in a Patient with a CIED