Should cardiac resynchronization therapy be considered for patients with severe chronic kidney disease?

Abstract

Purpose: Chronic kidney disease (CKD) is common in patients with chronic heart failure (CHF) and associated with poor prognosis. Few data are available regarding the benefit of CRT in patients with severe CKD where it may be avoided due to concerns over implant complications. We evaluated whether CRT is safe and beneficial in patients with CKD stage 3b or worse. Methods: Analysis of patients undergoing CRT at 2 centres (2009-11). Patients grouped by estimated glomerular filtration rate (eGFR) ≥45 and <45 ml/min/1.73m2 (CKD class 3b-5). Baseline demographics, complications, change in renal function and outcomes were compared between groups Results: 429 patients were included. Of these 26% had eGFR <45 ml/min/1.73m2 (table). Use of CRT-D was similar between groups. Co-morbidities are common in both groups (overall AF 24%, diabetes 25%, hypertension 44%). Major complication rates were similar between groups; no patients experienced acute renal failure. Both groups exhibited symptomatic benefit: 65% of patients with eGFR≥45 and 71% with eGFR<45 improved by ≥1 NYHA class. The majority of patients had repeat assessment of renal function at 3 months with mean eGFR 60±15 (n=210) in those with eGFR≥45 and 36±12 (n=82) in patients in CKD3b-5. Demographics and outcomes for patients Conclusions: Significant CKD is common in patients undergoing CRT implantation. Whilst 1-yr mortality rates following CRT are greater in those in CKD class 3b-5, a similar improvement in symptom status was seen with no excess of implant related complications. Further evaluation is required to see if CRT may impact on renal function.