Increased Complication Rates of Cardiac Rhythm Management Devices in ESRD Patients

Arijit Dasgupta, Jessica Montalvo, Sara Medendorp, Donald M. Lloyd-Jones, Cybele Ghossein, Jeffrey Goldberger, Rod Passman

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background: Patients with end-stage renal disease (ESRD) have a high incidence of sudden cardiac death and may benefit from implantable cardioverter defibrillators (ICDs). However, ESRD also may predispose patients to device-related complications, potentially offsetting some of the benefits of prophylactic ICD placement. The purpose of this study is to compare the incidence of complications after cardiac rhythm management device (CRMD) implantation in patients with and without ESRD. Methods: An observational study was performed on 41 patients with ESRD and 123 controls without ESRD who had a CRMD (permanent pacemaker or ICD) implanted at a single institution from 1998 to 2005. Controls were matched for age, sex, type of device, and calendar year of device implantation. Primary and secondary end points were any complication and complications requiring intervention, respectively. Results: 23 complications occurred in 16 of 41 patients with ESRD (39%) versus 13 complications in 13 of 123 matched controls (11%; P < 0.001). Major complications occurred in 29% of patients with ESRD versus 5% of controls (P < 0.001), whereas minor complications occurred in 17% and 6%, respectively (P < 0.03). Hematoma, thrombosis, and device-related complications, including elevated defibrillation thresholds, were more common in patients with ESRD (P < 0.05 for all), and there also was a nonsignificant trend toward greater infection risk (P = 0.1). There were no fatal complications in either group. Conclusions: Patients with ESRD had greater complication rates after CRMD implantation compared with matched controls, but these complications did not result in death. These results should be considered when evaluating patients with ESRD for prophylactic CRMD implantation, but do not support withholding such therapy.

Original languageEnglish (US)
Pages (from-to)656-663
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume49
Issue number5
DOIs
StatePublished - May 1 2007
Externally publishedYes

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Chronic Kidney Failure
Equipment and Supplies
Implantable Defibrillators
Sudden Cardiac Death
Incidence
Hematoma
Observational Studies
Thrombosis
Infection

Keywords

  • complications
  • defibrillator
  • Dialysis
  • pacemaker

ASJC Scopus subject areas

  • Nephrology

Cite this

Dasgupta, A., Montalvo, J., Medendorp, S., Lloyd-Jones, D. M., Ghossein, C., Goldberger, J., & Passman, R. (2007). Increased Complication Rates of Cardiac Rhythm Management Devices in ESRD Patients. American Journal of Kidney Diseases, 49(5), 656-663. https://doi.org/10.1053/j.ajkd.2007.02.272

Increased Complication Rates of Cardiac Rhythm Management Devices in ESRD Patients. / Dasgupta, Arijit; Montalvo, Jessica; Medendorp, Sara; Lloyd-Jones, Donald M.; Ghossein, Cybele; Goldberger, Jeffrey; Passman, Rod.

In: American Journal of Kidney Diseases, Vol. 49, No. 5, 01.05.2007, p. 656-663.

Research output: Contribution to journalArticle

Dasgupta, A, Montalvo, J, Medendorp, S, Lloyd-Jones, DM, Ghossein, C, Goldberger, J & Passman, R 2007, 'Increased Complication Rates of Cardiac Rhythm Management Devices in ESRD Patients', American Journal of Kidney Diseases, vol. 49, no. 5, pp. 656-663. https://doi.org/10.1053/j.ajkd.2007.02.272
Dasgupta, Arijit ; Montalvo, Jessica ; Medendorp, Sara ; Lloyd-Jones, Donald M. ; Ghossein, Cybele ; Goldberger, Jeffrey ; Passman, Rod. / Increased Complication Rates of Cardiac Rhythm Management Devices in ESRD Patients. In: American Journal of Kidney Diseases. 2007 ; Vol. 49, No. 5. pp. 656-663.
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AU - Ghossein, Cybele

AU - Goldberger, Jeffrey

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N2 - Background: Patients with end-stage renal disease (ESRD) have a high incidence of sudden cardiac death and may benefit from implantable cardioverter defibrillators (ICDs). However, ESRD also may predispose patients to device-related complications, potentially offsetting some of the benefits of prophylactic ICD placement. The purpose of this study is to compare the incidence of complications after cardiac rhythm management device (CRMD) implantation in patients with and without ESRD. Methods: An observational study was performed on 41 patients with ESRD and 123 controls without ESRD who had a CRMD (permanent pacemaker or ICD) implanted at a single institution from 1998 to 2005. Controls were matched for age, sex, type of device, and calendar year of device implantation. Primary and secondary end points were any complication and complications requiring intervention, respectively. Results: 23 complications occurred in 16 of 41 patients with ESRD (39%) versus 13 complications in 13 of 123 matched controls (11%; P < 0.001). Major complications occurred in 29% of patients with ESRD versus 5% of controls (P < 0.001), whereas minor complications occurred in 17% and 6%, respectively (P < 0.03). Hematoma, thrombosis, and device-related complications, including elevated defibrillation thresholds, were more common in patients with ESRD (P < 0.05 for all), and there also was a nonsignificant trend toward greater infection risk (P = 0.1). There were no fatal complications in either group. Conclusions: Patients with ESRD had greater complication rates after CRMD implantation compared with matched controls, but these complications did not result in death. These results should be considered when evaluating patients with ESRD for prophylactic CRMD implantation, but do not support withholding such therapy.

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KW - Dialysis

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