BACKGROUND Cardiac resynchronization therapy (CRT) improves functional status, reduces heart failure (HF) hospitalizations and decreases mortality. Several co-morbidities including renal function affect outcomes with CRT. However, moderate to severe chronic kidney disease (CKD) was an exclusion criteria in the large randomized control trials. OBJECTIVE To evaluate the association of renal function on survival following CRT implantation. METHODS This was a retrospective analysis of 432 consecutive patients implanted with an ICD with CRT (CRT-D). The primary endpoint was defined as death by any cause, and it was determined using hospital records and the United States Social Security Death Index. A Kaplan Meier analysis was performed separating renal dysfunction into renal stage based on glomerular filtration rate. Multivariate analysis was performed to assess the clinical predictors of mortality. RESULTS Patients were followed for up to 12 years with a mean follow up time of 4.3 ± 3.2 years. A total 164 patients (39.3 %) died over the course of the study. Patients with normal and mild renal disease (Stages 1 and 2) had improved survival compared with those with moderate, severe, or end stage (Stages 3–5) renal disease. This effect remained statistically significant after multivariate analysis. The estimated five year mortality was 36.3% for stage 1, 33.4 % for stage 2, 40.6% for stage 3, and 62.1% for stage 4/5 kidney disease (p = 0.004 by log rank test). CONCLUSION CKD is strong and independent predictor of long term mortality among patients undergoing CRT-D implantation.

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