Usefulness and Consequences of Cardiac Resynchronization Therapy in Dialysis-Dependent Patients With Heart Failure
What is the role of cardiac resynchronization therapy (CRT) in patients with end-stage renal disease (ESRD) on dialysis?
Authors from a single center studied their experience with a cohort of patients from May 24, 2002 to February 9, 2012, with ESRD and CRT. The primary endpoint was all-cause mortality and echocardiographic response. Echocardiographic evidence was defined as ≥5% absolute increase in ejection fraction (EF). Secondary endpoints included time until heart failure (HF) hospitalization, time until all-cause hospitalization, and the combined endpoint of HF hospitalization or death.
Fifteen dialysis-dependent patients with HF were implanted with CRT. Twenty percent of the subjects were women. The mean EF was 21 ± 7%, 53% had a left bundle branch block, and 67% had an ischemic cardiomyopathy. Eighty-seven percent of the patients had CRT with defibrillator. By 6-month follow-up, one third of the patients had died. At 3 years, Kaplan-Meier modeling predicted a 31% incidence of HF hospitalization, 100% incidence of hospitalization for any cause, 73% mortality, and 82% incidence of HF hospitalization or death. Patients on dialysis did not demonstrate a significant improvement in EF or LV diameters.
The authors concluded that CRT implantation in patients with ESRD and HF appears safe, with no major complications. There was variable evidence of improvement in echocardiographic parameters.
Further studies with a larger cohort of patients are needed to determine the role of CRT in ESRD patients.
Keywords: Myocardial Ischemia, Defibrillators, Kidney Failure, Chronic, Intracellular Signaling Peptides and Proteins, Cardiac Resynchronization Therapy, Heart Diseases, Renal Dialysis, Cardiac Pacing, Artificial, Heart Failure, Bundle-Branch Block, Parkinson Disease, Hospitalization, Renal Insufficiency, Chronic
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