Cardiac Resynchronization Therapy prevents progression of renal failure in heart failure patients

Abstract

BackgroundThe goal of this study is to assess the effect of cardiac resynchronization therapy (CRT) over time on renal function and its impact on mortality. The effect of CRT on renal function in patients with heart failure is not well understood.MethodsAll patients who underwent CRT implantation at University of Kansas between year 2000 and 2009 were reviewed and patients who had pre and post CRT renal function studied were included in our study. Stages of chronic kidney disease (CKD) were defined based on Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. The effect of CRT on renal and cardiac function were studied at short term (≤6 months post implantation) and long term (>6 months).ResultsA total of 588 patients with mean age of 67 ± 12 yrs were included in the study. CRT responders (defined by increase in LVEF ≥ 5%) were 54% during short term follow-up and 65% on long term follow-up. When compared to baseline, there was no significant deterioration in mean Glomerular Filtration Rate (GFR) during follow up. When analyzed based on the stages of CKD, there was significant improvement of renal function in patients with advanced kidney disease. Multivariate logistic regression analysis showed that stable GFR or an improvement in GFR independently predicted mortality after adjusting for co-morbidities.ConclusionsCRT was associated with stabilization of renal function in patients with severe LV dysfunction and improvement in stage 4 and 5 CKD. Improved renal function was associated with a lower mortality.

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

“…There is no broad consensus of the relative effectiveness of CRT-D over CRT-P, and therefore studies looking at the all-cause death rate and HF death rate could prove to be important in reducing the uncertainty around cost-effectiveness results. In addition, given the high proportion of eligible patients not responding to CRT [7] or not needing the addition of an ICD [5], future studies need to better identify CRT-P patients that will have a reasonable life expectancy when treated with CRT-D. This would bring down avoidable costs, and consequently improve cost-effectiveness of CRT-D over CRT-P.…”

“…The addition of an implantable cardioverter defibrillator to the resynchronization therapy (CRT-D) can further reduce the risk of death from any cause by more than 8 % (compared to CRT-P) [3], while the risk of sudden death (SCD) can be reduced by 23 % [4–6]. However, overall costs of CRT-D are high and it is reported that about 25 to 35 % of the patients do not respond to CRT-P [7] while implantable cardioverter defibrillators (ICDs) are not always needed to deliver the therapy [5]. …”

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

“…CRT response is associated with the stabilization or improvement of renal function, which, in turn, is associated with lower mortality [52, 53]. A meta-analysis suggested that diabetic patients with advanced HF who received CRT exhibited higher total mortality than nondiabetic patients [54].…”

Pump up the volume: Cardiac resynchronization therapy to improve renal function

“…present data from a single center (University of Kansas Medical Center, MO, USA) on the effect of CRT on renal function [10]. In a cohort of 558 patients who underwent CRT implants at their institution, 80% has mild renal dysfunction (Stage 2 or 3) at baseline.…”

“…Transvenous techniques run the risk of worsening renal function with the use of radiographic contrast used to define coronary sinus anatomy. In the present study [10], the operators used minimal contrast (40–45 cc) to minimize renal damage and utilized hydration and sodium bicarbonate over the 24-hour period around the implantation. Other than maintenance of adequate hydration and maintaining adequate urine flow in the post exposure period, it is unclear whether any other pre-treatment alters the risk of contrast nephropathy.…”