Abstract 13947: Cardiac Resynchronization Therapy Prevents Progression of Renal Failure in Heart Failure Patients
Introduction The effect of cardiac resynchronization therapy (CRT) on renal function in patients with heart failure is not well understood. We hypothesized that response to CRT would prevent worsening of renal function.
Methods All patients who underwent CRT implantation at University of Kansas between 2005 and 2008 were reviewed and patients who had pre and post CRT renal function studied were included in our study. Stages of chronic kidney disease (CKD) were defined based on baseline glomerular filtration rate (GFR in ml/min); stage 1 (>90), stage 2 (60 to 90), stage 3 (30 to 59), stage 4 (15 to 29) and stage 5 (< 15). The effect of CRT on renal and cardiac function were studied at short term (≤ 6 months post implantation) and long term (> 6 months).
Results A total of 163 patients with mean age of 67 ± 11 yrs were included in the study. Twenty nine percent were women, 36% were diabetic, 37% had atrial fibrillation, 67% had hypertension, 64% had coronary artery disease, and 34% had CKD. The average short term follow up duration was 127 ± 61 days and the average long term follow up duration was 414 ± 180 days. Sixty Eight % of patients had an improvement in ejection fraction (EF) ≥ 5% and 66% had improvement in GFR during follow up. When compared to baseline, there was no significant deterioration in mean GFR during follow up (short term: 56 ± 23 vs. 54 ± 23, p 0.2 and long term: 57 ± 22 vs. 57 ± 25, p = 0.9). When analyzed based on the stages of CKD, there was significant improvement of renal function in patients with stage 4 CKD during long term follow up and no significant worsening of renal function in stages 1 to 3. (Table) Differences in mortality among those who had improvement in GFR vs. those who did not, failed to reach statistical significance (30% vs. 38%, p = 0.3).
Conclusions Renal function in Heart Failure patients with CRT improves renal function in patients with advanced CKD (stage 4) and stabilizes it in those with early stages of the disease.
- © 2011 by American Heart Association, Inc.