Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
Department of Medicine, University of California Davis Medical Center, Sacramento, California.
Heart Rhythm. 2024 Sep;21(9):1695-1702. doi: 10.1016/j.hrthm.2024.03.1816. Epub 2024 Apr 2.
Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited.
The objective of this study was to evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations.
National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with CKD and ESRD who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study end points assessed included inpatient complications, outcomes, and resource utilization of leadless pacemaker implantations.
A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n = 5245 [18.1%]) and ESRD (n = 3790 [13.1%]) were younger than patients without CKD and had higher prevalence of important comorbidities. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (CKD: adjusted odds ratio [aOR], 1.62 [95% CI, 1.40-1.86]; ESRD: aOR, 1.38 [95% CI, 1.18-1.63]) and prolonged length of stay (CKD: aOR, 1.55 [95% CI, 1.46-1.66]; ESRD: aOR, 1.81 [95% CI 1.67-1.96]). ESRD was also associated with higher hospitalization costs (aOR, 1.63; 95% CI, 1.50-1.77) and major complications (aOR, 1.33; 95% CI, 1.13-1.57) after leadless pacemaker implantation.
Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay and inpatient mortality.
无导线起搏器已成为肾病患者经静脉起搏器的一种有前途的替代方法。然而，基于肾功能障碍研究无导线起搏器结果和并发症的研究有限。
本研究旨在评估慢性肾脏病（CKD）和终末期肾病（ESRD）与无导线起搏器植入术的住院并发症和结局的关系。
使用美国国家住院患者样本和国际疾病分类，第十次修订版代码，从 2016 年至 2020 年确定在美国接受无导线起搏器植入的 CKD 和 ESRD 患者。评估的研究终点包括无导线起搏器植入的住院并发症、结局和资源利用。
共确定了 29005 例无导线起搏器植入。CKD（n=5245[18.1%]）和 ESRD（n=3790[13.1%]）患者比无 CKD 患者年轻，且合并症的患病率更高。在初步分析中，ESRD 与主要并发症、周围血管并发症和住院死亡率较高相关。经多变量调整后，CKD 和 ESRD 与住院死亡率相关（CKD：调整后优势比[OR]，1.62[95%CI，1.40-1.86]；ESRD：OR，1.38[95%CI，1.18-1.63]）和住院时间延长（CKD：OR，1.55[95%CI，1.46-1.66]；ESRD：OR，1.81[95%CI，1.67-1.96]）。ESRD 还与无导线起搏器植入后的住院费用（OR，1.63；95%CI，1.50-1.77）和主要并发症（OR，1.33；95%CI，1.13-1.57）较高相关。
大约三分之一接受无导线起搏器植入的患者患有 CKD 或 ESRD。CKD 和 ESRD 与住院时间延长和费用增加以及住院死亡率增加有关。
