Abstract 17791: Renal Response in Patients with Chronic Kidney Disease (CKD) Predicts Outcome Following Cardiac Resynchronization Therapy (CRT)
Introduction CKD severity has been associated with worsened morbidity and mortality in chronic heart failure (HF). Although renal improvement following CRT has been linked to improved outcomes, there is a paucity of information on the impact of CRT in patients with CKD IV (GFR < 30 ml/min).
Methods This was a prospective cohort study of patients undergoing CRT for conventional indications at a single center. Patients selected had creatinine assessed within 6 months prior to CRT implant and 6-12 months after implant. GFR was calculated using the MDRD equation and median creatinine values. Patients with GFR increase of at least 10 mL/min were identified as “renal responders.” Echocardiographic outcomes were assessed at 6 months. Co-primary endpoints were composite of time to all-cause death, transplant, and LVAD at 5 years and time to HF hospitalization at 2 years.
Results The cohort consisted of 219 patients: 86% male, age 68.5 ± 12.9 years, LVEF 23.6 ± 7%, QRS duration 161.9 ± 30.3 ms. Comorbidities included diabetes (45%) and hypertension (75%). CKD severity at baseline was: Class II (n=53), Class III (n=117), and Class IV (n=27). Patients with increasing severity of CKD demonstrated significantly increased mortality (log rank p <0.0001) and HF hospitalization (log rank p = 0.005, Figure 1A) following CRT. Renal responders exhibited improvement in HF hospitalizations compared to non-responders (Figure 1B). This relationship held across all three classes of CKD. Multivariate analysis demonstrated that a worse baseline CKD class (OR=2.49, p=0.01) and improved LV reverse remodeling (OR=1.62 per 10% increase in LVEF, p=0.04) were predictors of an enhanced renal response. Patients with CKD class IV were the most likely to demonstrate renal response (p=0.02).
Conclusion Renal responders have improved outcomes following CRT among all pre-implant CKD classes, including patients with stage IV CKD. Both pre-implant CKD class and LV reverse remodeling predict renal response.
- © 2012 by American Heart Association, Inc.