Cardiovascular Implantable Electronic Device Leads in CKD and ESRD Patients: Review and Recommendations for Practice

Abstract

Cardiovascular implantable electronic devices (CIEDs) are frequently utilized for management of cardiac dysrhythmias in patients with chronic kidney disease or end-stage renal disease receiving hemodialysis. The survival benefit from use of implantable cardioverter defibrillators in patients with CKD or ESRD is not as clear as in the general population, particularly when used for primary prevention of sudden cardiac death. Transvenous CIED leads are associated with central vein stenosis resulting in significant adverse consequences for existing or future arteriovenous access. Venous hypertension from CIED lead-related central vein stenosis is a challenging clinical problem and may require repeated percutaneous interventions, replacement of the CIED, or creation of alternative arteriovenous access. Infections associated with transvenous CIED leads are more frequent and associated with worse outcomes in patients with renal disease. Epicardial CIED leads or other nontransvenous devices may reduce complications of both central venous stenosis and endovascular infection in these vulnerable patients. Consensus recommendations are offered for avoidance and management of complications arising from the use of CIEDs and arteriovenous hemodialysis access.

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…A retrospective study found that patients on chronic dialysis who received an S‐ICD had no device‐related infections over a mean follow‐up of 7 months 87. Moreover, a reduced risk of central venous stenosis and hematogenous and endocardial bacterial infections was noted in a recent case series 89. This result was later confirmed in other studies 90.…”

Study on the Clinical Significance and Related Factors of Thirst and Xerostomia in Maintenance Hemodialysis Patients

“…Most patients with end-stage renal disease (ESRD) under hemodialysis appear multiple complications, especially cardiovascular disease [1]. High fluid intake from daily diet leads to high inter dialytic weight gain (IDWG) in patients during dialysis session.…”

Kidney transplantation and cardiomyopathy: Concepts and controversies in clinical decision‐making

“…Subcutaneous ICD (S‐ICD) implantation in dialysis patients is not associated with an excess risk of implant‐related complications . Several other studies reported a reduced incidence of central vein stenosis and bloodstream mediated infection with S‐ICD . Therefore, considering the elevated risk of SCD in ESRD patients, S‐ICD may be recommended for primary prevention of SCD.…”