Abstract 9714: The Impact of Chronic Kidney Disease on Complications and All-Cause Mortality After Implantable Device Replacement or Upgrade: Survival Analyses From the REPLACE Registry
Background: Chronic kidney disease (CKD) increases the risk for a variety of arrhythmias and these patients often require cardiac implantable electronic device (CIED) implantation. We sought to assess the impact of CKD on complications and mortality in REPLACE.
Methods: REPLACE was a prospective registry of patients undergoing CIED replacement without or with the intent to add or revise one or more leads. CKD stage was based on the National Kidney Foundation classification: stage 1, normal GFR 90; stage 2, GFR 69-89; stage 3, GFR 30-59; stage 4, GFR 15-29; stage 5, GFR <15 or on renal dialysis. The 6-month complication rate and mortality was determined.
Results: GFR data were available in 1662 (95%) of 1744 patients; by 6-months of follow-up, 254 (15%) of these patients experienced a complication and 67 (4%) patients died. CKD stage did not significantly impact the likelihood of patients experiencing a complication. Cox multivariate analysis identified 5 predictors of survival: prior admission for heart failure (HR 3.05; 95% CI 1.76-5.26), NYHA class III/IV (HR 1.87; 95% CI: 1.07-3.25), antiarrhythmic drug use (HR 1.80; 95% CI: 1.08-2.98), cerebrovascular disease (HR 1.90; 95% CI: 1.11-3.25), and CKD stage (HR 1.5; 95% CI: 1.12-2.0). Patients with stage I-II CKD had a 2.4% 6-month all-cause mortality. In comparison, the mortality was more than 2-fold higher in stage III patients (5.3%), 3-fold higher in stage IV patients (8.6%), and 6-fold higher in stage V patients (16.0%) (Figure).
Conclusions: In this prospective registry, CKD was an independent and potent risk factor for mortality. The increase in mortality as a function of CKD stage became evident by the first month following the CIED procedure. Importantly, the excess mortality was not driven by procedure-related complications. Future investigation needs to be directed towards identification of the mechanisms of death and methods to reduce mortality in patients with CKD who undergo CIED replacement.
- © 2012 by American Heart Association, Inc.