Jiwani Sania, Chan Wan-Chi, Gadre Akshaya, Sheldon Seth, Hu Jinxiang, Pimentel Rhea, Noheria Amit, Gupta Kamal
Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas.
Heart Rhythm. 2025 Mar;22(3):744-751. doi: 10.1016/j.hrthm.2024.09.016. Epub 2024 Sep 12.
End-stage kidney disease (ESKD) patients are prone to bloodstream infections that may result in a higher risk of cardiac implantable electronic device (CIED) infections.
The objective of this study was to assess the incidence, risk predictors, management strategies, and long-term outcomes of CIED infections in ESKD patients undergoing de novo CIED implantation.
This is a retrospective study using the United States Renal Data System. ESKD patients with de novo CIED implantation between January 1, 2006, and September 30, 2014, were included. Patients were observed until death, kidney transplantation, end of Medicare coverage, or September 30, 2015, to assess incidence of CIED infection. Management approach was determined from procedure codes for lead extraction within 60 days of CIED infection diagnosis. Patients with CIED infection were observed until December 31, 2019, to assess long-term outcomes.
Of 15,515 ESKD patients undergoing de novo CIED implantation, incidence of CIED infection was 4.8% during a median follow-up of 1.3 years. The presence of a defibrillator (adjusted hazard ratio [aHR], 1.48), higher body mass index (aHR, 1.01), and younger age (aHR, 0.96) were independent risk factors for CIED infection. Lead extraction occurred in only 50.71% of patients by 60 days. After propensity score matching, the 3-year mortality was higher in those who did not undergo lead extraction compared with those who did (80.3% vs 72.3%) and time to mortality was shorter (0.3 vs 0.6 year). Only 13.8% of patients underwent reimplantation with a new CIED after lead extraction.
CIED infections occur frequently in ESKD patients and are associated with a high mortality. Early lead extraction is not performed routinely but is associated with improved survival.
终末期肾病（ESKD）患者容易发生血流感染，这可能会导致心脏植入式电子设备（CIED）感染风险更高。
本研究的目的是评估初次植入CIED的ESKD患者中CIED感染的发生率、风险预测因素、管理策略及长期结局。
这是一项使用美国肾脏数据系统的回顾性研究。纳入2006年1月1日至2014年9月30日期间初次植入CIED的ESKD患者。观察患者直至死亡、肾移植、医疗保险覆盖结束或2015年9月30日，以评估CIED感染的发生率。根据CIED感染诊断后60天内的导线拔除程序编码确定管理方法。对发生CIED感染的患者观察至2019年12月31日，以评估长期结局。
在15515例初次植入CIED的ESKD患者中，中位随访1.3年期间，CIED感染发生率为4.8%。除颤器的存在（调整后风险比[aHR]，1.48）、较高的体重指数（aHR，1.01）和较年轻的年龄（aHR，0.96）是CIED感染的独立危险因素。到60天时，仅50.71%的患者进行了导线拔除。倾向评分匹配后，未进行导线拔除的患者3年死亡率高于进行导线拔除的患者（80.3%对72.3%），且死亡时间更短（0.3年对0.6年）。导线拔除后，只有13.8%的患者接受了新的CIED再植入。
CIED感染在ESKD患者中频繁发生，且与高死亡率相关。早期导线拔除未常规进行，但与生存率提高相关。
