Abstract 14999: Cardiac Resynchronization Therapy in Stage Four (Pre-Dialysis) Chronic Kidney Disease patients
Background: 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 on pre-dialysis patients. Therefore, the aim of this study was to evaluate the impact of CRT on 1) renal function and 2) long-term prognosis in chronic kidney disease (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. As a control group, 22 implantable cardioverter-defibrillator (ICD) recipients in CKD stage 4 and matched for age, gender and left ventricular (LV) function were enrolled. CKD stage 4 was defined by a GFR of 15-29 ml/min/1.73 m2. CRT recipients with ≥15% reduction in LV end-systolic volume at 6-month follow-up were classified as responders to CRT. 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-month follow-up, 17 CRT patients (32%) were classified as responders. Significant improvement in GFR was observed at follow-up in CRT responders (from 24±4 to 28±5, p=0.004), and 47% of them changed from CKD stage 4 to stage 3. 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). Importantly, a superior overall survival at 5-year follow-up was observed among CRT responders as compared to CRT non-responders and ICD recipients (log rank p=0.014; see Figure)
Conclusion: CRT response in pre-dialysis patients is associated with increase in GFR and prevention from further renal function impairment. In particular, response to CRT is associated with better long-term prognosis.
- © 2012 by American Heart Association, Inc.