Patients with moderate-to-severe chronic kidney disease who received cardiac resynchronization therapy with defibrillator (CRT-D) may have a lower risk of hospitalization for heart failure or death compared to patients who received only an implantable cardioverter defibrillator (ICD), according to a study published Dec. 7 in the Journal of the American College of Cardiology.

The study used data from ACC’s ICD Registry linked with claims from the Centers for Medicare and Medicaid, and examined records of 10,628 patients with kidney disease who were eligible for either of these devices between January 2006 and December 2009. Of that group, 87 percent received CRT-D. 

After adjusting for many factors, including age, sex, level of chronic kidney disease, and presence of atrial fibrillation or flutter, researchers found a 15 to 20 percent reduction in the risk of hospitalization for heart failure or death in patients who received CRT-D compared with those who received an ICD.

According to Daniel J. Friedman, MD, the study’s lead author and a fellow in cardiology at Duke University Hospital, in Durham, NC, the results from the study corroborate the observed association between CRT-D and improved outcomes for patients with advanced kidney disease. But the study also shows that CRT-D was no more effective than ICDs in reducing progression to advanced kidney disease.  

Friedman notes that the study’s findings support the use of CRT-D independent of kidney function, largely because it is associated with a reduction in risk of heart failure hospitalization and mortality. “These results, however, should be confirmed by prospective randomized studies,” he says. 

In an accompanying editorial, John G.F. Cleland, MD, PhD, FACC, et al., state that with only a modest reduction in hospitalization risk for heart failure and death, it is unclear whether this population actually benefits from the treatment, especially without data from a device-free control group.

They note that even with CRT-D, more than half of those patients with end-stage kidney disease die within three years. Therefore, in these instances, it may be better not to “implant, at some risk and discomfort, an expensive piece of technology, which may be attended by substantial morbidity” and instead “have a frank discussion with the patient about the limits of modern medicine,” they conclude.

Keywords: Atrial Fibrillation, Cardiac Resynchronization Therapy, Defibrillators, Defibrillators, Implantable, Heart Failure, Hospitalization, Kidney, Kidney Failure, Chronic, Medicaid, Medicare, Prospective Studies, Registries, Renal Insufficiency, Chronic, ICD Registry, National Cardiovascular Data Registries

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