Abstract
Purpose: Reduced glomerular filtration rate (GFR) in heart failure patients is associated with poor prognosis. Cardiac resynchronization therapy (CRT) has been associated with cardiac and renal function improvements, but no data are available in chronic kidney disease (CKD) stage 4 patients. Therefore, we evaluated the impact of CRT on 1) renal function and 2) long-term prognosis in CKD stage 4 patients. Methods: A total of 58 consecutive CRT (n=58) patients (mean age 73±10 years, 60% male) in CKD stage 4 with echocardiographic and renal function evaluation at baseline and 6-month follow-up were included. CKD stage 4 was defined by a GFR of 15-29 ml/min/1.73 m2. As a control group, 22 implantable cardioverter-defibrillator (ICD) recipients in CKD stage 4 were selected. CRT recipients with ≥15% reduction in LV end-systolic volume at 6-month follow-up were classified as CRT responders. During long-term follow-up (median 27 months, IQR 12-45 months) all-cause mortality was recorded. Results: At baseline, no significant differences were observed between CRT and ICD recipients except for QRS duration (173±26 vs. 130±30 ms,p<0.001). At 6 months, 17 CRT patients (32%) were classified as responders. The GFR increased significantly in CRT responders at follow-up (from 24±4 to 28±5,p=0.004). In turn, GFR did not improve in CRT non-responders (from 25±4 to 26±8,p=0.362) and in ICD recipients (from 25±4 to 23±10,p=0.385). More importantly, a superior survival at 5-year follow-up was observed among CRT responders as compared to CRT non-responders and ICD recipients (p=0.014;Figure). ![Figure][1] Kaplan-Meier survival curves Conclusion: Response to CRT in CKD stage 4 patients is associated with increased GFR, prevention from further renal function impairment and finally with better long-term prognosis. [1]: pending:yes
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