University of Rochester Medical Center, Rochester, New York, USA.
J Cardiovasc Electrophysiol. 2011 Oct;22(10):1099-104. doi: 10.1111/j.1540-8167.2011.02066.x. Epub 2011 Apr 13.
Patients with chronic kidney disease (CKD) have increased morbidity following invasive procedures. We hypothesized that patients with CKD have higher complication rates following device implantation than patients with normal renal function.
We reviewed the medical records of patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. The estimated glomerular filtration rate (GFR) was calculated using the Cockroft-Gault equation. Those with GFR ≥ 90 cc/min served as controls. The remainder was grouped according to American Kidney Foundation stages of CKD. Bleeding complications were defined as need for pocket exploration or blood transfusion; cardiac tamponade; or hematoma requiring pressure dressing, change in medications or prolonged hospitalization. Infection was defined as infection of the pocket or lead system, or development of bacteremia/sepsis within 60 days.
There were 82 bleeding complications (5.7%) and 7 infections (0.5%) temporally related to device implantation in 1,440 patients. End-stage renal disease (ESRD), defined as GFR < 15 mL/min or need for dialysis, was identified in 32 patients. Infection rates were significantly higher in patients with ESRD versus controls (12.5% vs 0.2%; P < 0.0001). A significant increase in bleeding complications was observed in ESRD versus controls (21.9% vs 3.2%, respectively; P<0.0001). Bleeding complications were considerably greater than controls in moderate (GFR 30-59 mL/min) and severe (GFR 15-29 mL/min) CKD (7.4% and 9.8% vs 3.2%, respectively; P < 0.005).
ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.
患有慢性肾脏病（CKD）的患者在接受侵入性操作后发病率增加。我们假设，与肾功能正常的患者相比，CKD 患者在接受器械植入后并发症发生率更高。
我们回顾了 2004 年 8 月至 2007 年 8 月期间接受 ICD 或起搏器植入的患者的病历。肾小球滤过率（GFR）使用 Cockroft-Gault 方程计算。GFR≥90 cc/min 的患者作为对照组。其余患者根据美国肾脏病基金会 CKD 分期进行分组。出血并发症定义为需要进行囊袋探查或输血；心脏压塞；或需要加压包扎、改变药物或延长住院时间的血肿。感染定义为囊袋或导联系统感染，或在 60 天内发生菌血症/败血症。
在 1440 例患者中，有 82 例（5.7%）出血并发症和 7 例（0.5%）与器械植入相关的感染。32 例患者被诊断为终末期肾病（ESRD），定义为 GFR<15 mL/min 或需要透析。与对照组相比，ESRD 患者的感染率明显更高（12.5%对 0.2%；P<0.0001）。与对照组相比，ESRD 患者出血并发症显著增加（分别为 21.9%和 3.2%；P<0.0001）。在中度（GFR 30-59 mL/min）和重度（GFR 15-29 mL/min）CKD 患者中，出血并发症明显高于对照组（分别为 7.4%和 9.8%对 3.2%；P<0.005）。
ESRD 显著增加出血和器械相关感染的风险。两种并发症的风险与 CKD 的严重程度平行。需要进一步研究以降低这一高危人群的不良结局。
