Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Semin Dial. 2021 Jan;34(1):17-30. doi: 10.1111/sdi.12937. Epub 2020 Dec 9.
Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta-analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all-cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty-six studies (n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD-only, CRT(D) was associated with lower risk of all-cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non-primary prevention (secondary prevention or both), the analysis revealed a lower risk of all-cause mortality in the ICD group than in the no-ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all-cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30-59 ml/min/1.73 m ), CKD4/5 (eGFR <30 ml/min/1.73 m ) was observed to have a significantly higher risk of all-cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all-cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.
心脏再同步治疗伴或不伴除颤器（CRT(D)）和植入式心脏复律除颤器（ICD）可降低心律失常或心力衰竭特异性死亡率的风险，并改善慢性肾脏病（CKD）或透析患者的预后。本研究的目的是进行一项荟萃分析，以调查 CRT(D)/ICD 与肾功能不全之间的关系。系统地检索了 Cochrane 图书馆、Web of Science、Embase 和 Pubmed 从成立到 2019 年 10 月 29 日的数据。我们纳入了报告 CRT(D)/ICD 治疗后肾功能不全患者全因死亡率的研究。共纳入 26 项研究（n=119263），从两个方面探讨了 CRT(D)/ICD 与肾功能不全的关系：（1）与 ICD 相比，CRT(D)可降低 CKD 患者全因死亡率的风险（比值比（OR）=0.67；95%置信区间（CI），0.60 至 0.75）。对于非一级预防（二级预防或两者兼有），分析显示 ICD 组的全因死亡率低于无 ICD 组（OR=0.47；95%CI，0.40 至 0.55）。（2）与对照组相比，CKD 增加全因死亡率（OR=2.12；95%CI，1.85 至 2.44），透析也是如此（OR=2.53；95%CI，2.34 至 2.73）。此外，与 CKD3（eGFR：30-59 ml/min/1.73 m ）相比，CKD4/5（eGFR <30 ml/min/1.73 m ）全因死亡率的风险显著更高（OR=2.70；95%CI，1.93 至 3.80）。本综述清楚地表明 CRT(D)/ICD 与全因死亡率方面的肾功能不全之间存在明确的关联，可为 CRT(D)/ICD 的临床应用提供参考。
