End-stage renal disease predicts complications in pacemaker and ICD implants

Abstract

Introduction: Patients with chronic kidney disease (CKD) have increased morbidity following invasive procedures. We hypothesized that patients with CKD have higher complication rates following device implantation than patients with normal renal function.

Methods: We reviewed the medical records of patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. The estimated glomerular filtration rate (GFR) was calculated using the Cockroft-Gault equation. Those with GFR ≥ 90 cc/min served as controls. The remainder was grouped according to American Kidney Foundation stages of CKD. Bleeding complications were defined as need for pocket exploration or blood transfusion; cardiac tamponade; or hematoma requiring pressure dressing, change in medications or prolonged hospitalization. Infection was defined as infection of the pocket or lead system, or development of bacteremia/sepsis within 60 days.

Results: There were 82 bleeding complications (5.7%) and 7 infections (0.5%) temporally related to device implantation in 1,440 patients. End-stage renal disease (ESRD), defined as GFR < 15 mL/min or need for dialysis, was identified in 32 patients. Infection rates were significantly higher in patients with ESRD versus controls (12.5% vs 0.2%; P < 0.0001). A significant increase in bleeding complications was observed in ESRD versus controls (21.9% vs 3.2%, respectively; P<0.0001). Bleeding complications were considerably greater than controls in moderate (GFR 30-59 mL/min) and severe (GFR 15-29 mL/min) CKD (7.4% and 9.8% vs 3.2%, respectively; P < 0.005).

Conclusion: ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.