Abstract 18385: The Impact of Chronic Kidney Disease on Survival in Patients With Cardiac Resynchronization Therapy
Introduction: The prevalence of chronic kidney disease (CKD) is increasing worldwide and it is associated with increased risk of cardiac death. Cardiac resynchronization therapy (CRT) has been shown to increase survival in heart failure patients with left ventricular systolic dysfunction and interventricular conduction delay, but patients with moderate to severe CKD were excluded from the large pivotal randomized trials. Little is known regarding the impact of CKD on survival with CRT long-term.
Hypothesis: CKD reduced long-term survival among patients with CRT.
Methods: The follow up of a prospective cohort of 431 consecutive patients undergoing de novo CRT-D implantation from 2002-2010 was performed. The primary endpoint was all cause mortality and was determined using hospital records and the US Social Security Death Index. Glomerular filtration rate was calculated from pre-implant serum creatinine, weight, height, age and race using the Modified Diet in Renal Dysfunction equation. A Kaplan Meier survival analysis was performed grouping patients by CKD stage.
Results: Patients were followed for up to 12 years with a mean follow up duration of 4.7 ± 3.0 years. The cohort was 72% male with a mean age of 67 ± 11 years, ejection fraction of 25 ± 10 percent and QRS duration of 156 ± 24 msec. The patients with normal renal function and mild CKD (Stages 1 and 2) had improved survival compared with patients with moderate, severe or end stage kidney disease (Stages 3-5). The estimated five year survival was 68.9% for stage 1, 73.5% for stage 2, 55.5% for stage 3 and 45.4% for stage 4/5 CKD with a p<0.001 by log rank test . Multivariate analysis showed that CKD Stage, QRS duration and age were independent predictors of survival with CRT.
Conclusions: Renal disease is a strong predictor of long term survival with CRT. Moderate to severe CKD is associated with a near 2-fold increased mortality and this should be considered when making decision about the suitability for implantation.
- Cardiac Resynchronization Therapy
- Chronic Kidney Disease
- Heart Failure
- Kaplein Meier Curve
Author Disclosures: D.D. Daly: None. A. Maran: None. A. Waring: None. F. Cuoco: Research Grant; Modest; Boston Scientific. Consultant/Advisory Board; Modest; St. Jude, Biotronic. L. Sturdivant: None. R.B. Leman: None. M.R. Gold: Research Grant; Significant; Boston Scientific, Medtronic, St. Jude. Honoraria; Modest; Biotronic. Honoraria; Significant; Boston Scientific, Medtronic. Consultant/Advisory Board; Significant; Medtronic, St. Jude.
- © 2015 by American Heart Association, Inc.