Abstract 14214: Severe Renal Disease Increases the Risk for Device Related Complications in Patients with an Implantable Cardioverter Defibrillator
Introduction ICD therapy has become a proven and well-accepted therapy for the prevention of sudden cardiac death. However, a major part of the present patient population has serious comorbidities, influencing the positive effects of ICD therapy. One of the most important comorbidities is renal dysfunction, which might result in an increased risk for device related complications. In this study, the association between kidney function and the occurrence of device related complications was assessed.
Methods All patients in which an ICD or BIV-ICD was implanted in the LUMC, the Netherlands, between '96 and 2011 were included. Patients were stratified according to the American Kidney Foundation stages of renal disease: Glomerular Filtration Rate (GFR) ≤30, 30-59, 60-89 or GFR≥90 mL/min. During follow-up, device related complications requiring device explantation or device relocation were noted. Event rates were noted per 100 patient years.
Results A total of 3148 patients were implanted with an ICD of BIV-ICD. Average follow up was 48±39 months (79% male, 62±13 years). In 97 (3%) patients, at least one device related complication occurred (43 relocations, 54 extractions). When the complications are categorized according to the GFR, the event rate was 2.0 per 100 patient years (95% CI 0.8-4.4) in patients with severe kidney disease (GFR≤30) and approximately 0.91(95% CI 0.7-1.1) in all patients with a GFR≥30mL/min. When comparing patients with severe kidney disease with those who have a GFR≥30, the calculated rate ratios are 2.2 (95% CI 0.9-5.4, P=0.09) for all monitored complications and 4.0 (95% CI 1.6-10.1, P=0.003) for device explantations.
Conclusion This study demonstrates that severe kidney disease, is associated with an event rate for device related complications almost two times that of patients with a GFR≥30 mL/min. The total event rate seems to be comparable for all stages of renal disease above a GFR of 30 mL/min.
- © 2012 by American Heart Association, Inc.