Kichloo Asim, Solanki Dhanshree, Berger Ronald, Jamal Shakeel, Albosta Michael, Aljadah Michael, Khan Muhammad Zia, Kanjwal Khalil
Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.
Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA.
J Innov Card Rhythm Manag. 2023 Feb 15;14(2):5339-5347. doi: 10.19102/icrm.2023.14023. eCollection 2023 Feb.
Large-scale multi-hospital data on cardiac resynchronization therapy (CRT) device implantation in patients with chronic kidney disease (CKD) are currently lacking. The purpose of this study was to examine the incidence of CRT device implantation in patients hospitalized with CKD and the impact of CRT device implantation on hospital complications and outcomes. We analyzed the Nationwide Inpatient Sample from 2008-2014 to identify yearly trends in CRT device implantation during CKD hospitalizations. We compared CRT biventricular pacemakers (CRT-Ps) and CRT defibrillators (CRT-Ds). We also obtained rates of comorbidities and complications associated with CRT device implantations. From 2008-2014, the proportion of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-P devices consistently went up from 2008 to 2014 (from 12.3% to 23.8%, < .0001) compared to the number of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-D devices, which showed a consistent downward trend (from 87.7% to 76.2%, < .0001). During CKD hospitalizations, most CRT device implantations were performed in patients aged 65-84 years (68.6%) and in men (74.3%). The most common complication of CRT device implantation during hospitalizations involving CKD was hemorrhage or hematoma (2.7%). Patients hospitalized with CKD who developed any complication associated with CRT device implantation had 3.35-fold increased odds of mortality compared to those without complications (odds ratio, 3.35; 95% confidence interval, 2.18-5.16; < .0001). In summary, this study shows that CRT-P implantations became more common in CKD patients, while the rate of CRT-D implantations decreased over time. Hemorrhage or hematoma was the most common complication (2.7%), and the mortality risk was increased by 3.35 times in patients who developed periprocedural complications.
目前缺乏关于慢性肾脏病（CKD）患者心脏再同步治疗（CRT）设备植入的大规模多医院数据。本研究的目的是调查因CKD住院患者中CRT设备植入的发生率，以及CRT设备植入对医院并发症和结局的影响。我们分析了2008年至2014年的全国住院患者样本，以确定CKD住院期间CRT设备植入的年度趋势。我们比较了CRT双心室起搏器（CRT-P）和CRT除颤器（CRT-D）。我们还获得了与CRT设备植入相关的合并症和并发症发生率。2008年至2014年，与同时诊断为CKD并接受CRT-D设备的住院患者数量相比，同时诊断为CKD并接受CRT-P设备的住院患者比例从2008年到2014年持续上升（从12.3%升至23.8%，P<0.0001），而接受CRT-D设备的患者比例呈持续下降趋势（从87.7%降至76.2%，P<0.0001）。在CKD住院期间，大多数CRT设备植入手术是在65至84岁的患者（68.6%）和男性患者（74.3%）中进行的。在涉及CKD的住院期间，CRT设备植入最常见的并发症是出血或血肿（2.7%）。与未发生并发症的患者相比，因CKD住院且发生与CRT设备植入相关任何并发症的患者死亡几率增加了3.35倍（比值比，3.35；95%置信区间，2.18至5.16；P<0.0001）。总之，本研究表明，CRT-P植入在CKD患者中变得更为常见，而CRT-D植入率随时间下降。出血或血肿是最常见的并发症（2.7%），发生围手术期并发症的患者死亡风险增加了3.35倍。
