Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug;8(8):1293-303.
doi: 10.2215/CJN.00750113. Epub 2013 May 9.

Cardiac resynchronization therapy in CKD: a systematic review

Neha Garg  1 , George Thomas, Gregory Jackson, John Rickard, Joseph V Nally Jr, W H Wilson Tang, Sankar D Navaneethan
Affiliations

Cardiac resynchronization therapy in CKD: a systematic review

Neha Garg et al. Clin J Am Soc Nephrol. 2013 Aug.

Abstract

Background: Cardiac resynchronization therapy (CRT) confers morbidity and mortality benefits to selected patients with heart failure. This systematic review examined effects of CRT in CKD patients (estimated GFR [eGFR] <60 ml/min per 1.73 m(2)).

Design, setting, participants, & measurements: MEDLINE and Scopus (from 1990 to December 2012) and conference proceedings abstracts were searched for relevant observational studies and randomized controlled trials (RCTs). Studies comparing the following outcomes were included: (1) CKD patients with and without CRT and (2) CKD patients with CRT to non-CKD patients with CRT. Mortality, eGFR, and left ventricular ejection fraction data were extracted and pooled when appropriate using a random-effects model.

Results: Eighteen studies (14 observational studies and 4 RCTs) were included. There was a modest improvement in eGFR with CRT among CKD patients (mean difference 2.30 ml/min per 1.73m(2); 95% confidence interval, 0.33 to 4.27). Similarly, there was a significant improvement in left ventricular ejection with CRT in CKD patients (mean difference 6.24%; 95% confidence interval, 3.46 to 9.07). Subgroup analysis of three RCTs reported lower rates of death or hospitalization for heart failure with CRT (versus other therapy) in the CKD population. Survival outcomes of CKD patients (compared with the non-CKD population) with CRT differed among observational studies and RCTs.

Conclusions: CRT improves left ventricular and renal function in the CKD population with heart failure. Given the increasing use of cardiac devices, further studies examining the effects of CRT on mortality in CKD patients, particularly those with advanced kidney disease, are warranted.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study flow diagram. Included studies and reasons for exclusion of studies.
Figure 2.
Figure 2.
Survival in CKD patients with CRT versus non-CKD patients with CRT (observational studies only). CRT, cardiac resynchronization therapy; 95% CI, 95% confidence interval.
Figure 3.
Figure 3.
Mean difference in eGFR after CRT in patients with baseline CKD. eGFR, estimated GFR; CRT, cardiac resynchronization therapy.
Figure 4.
Figure 4.
Effect of CRT on LVEF in those with CKD. CRT, cardiac resynchronization therapy; LVEF, left ventricular ejection fraction; 95% CI, 95% confidence interval.
See this image and copyright information in PMC

References

    1. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 298: 2038–2047, 2007 - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351: 1296–1305, 2004 - PubMed
    1. Park M, Hsu CY, Li Y, Mishra RK, Keane M, Rosas SE, Dries D, Xie D, Chen J, He J, Anderson A, Go AS, Shlipak MG, Chronic Renal Insufficiency Cohort (CRIC) Study Group : Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol 23: 1725–1734, 2012 - PMC - PubMed
    1. Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, Townsend RR, Xie D, Cifelli D, Cohan J, Fink JC, Fischer MJ, Gadegbeku C, Hamm LL, Kusek JW, Landis JR, Narva A, Robinson N, Teal V, Feldman HI, Chronic Renal Insufficiency Cohort (CRIC) Study Group : Chronic Renal Insufficiency Cohort (CRIC) Study: Baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol 4: 1302–1311, 2009 - PMC - PubMed
    1. Kane GC, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC, Jr, Jacobsen SJ, Rodeheffer RJ: Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 306: 856–863, 2011 - PMC - PubMed

Publication types

MeSH terms