title: Increased complication rates of cardiac rhythm management devices in ESRD patients.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) have a high incidence of sudden cardiac death and may benefit from implantable cardioverter defibrillators (ICDs). However, ESRD also may predispose patients to device-related complications, potentially offsetting some of the benefits of prophylactic ICD placement. The purpose of this study is to compare the incidence of complications after cardiac rhythm management device (CRMD) implantation in patients with and without ESRD.
  
  
  METHODS
  An observational study was performed on 41 patients with ESRD and 123 controls without ESRD who had a CRMD (permanent pacemaker or ICD) implanted at a single institution from 1998 to 2005. Controls were matched for age, sex, type of device, and calendar year of device implantation. Primary and secondary end points were any complication and complications requiring intervention, respectively.
  
  
  RESULTS
  23 complications occurred in 16 of 41 patients with ESRD (39%) versus 13 complications in 13 of 123 matched controls (11%; P < 0.001). Major complications occurred in 29% of patients with ESRD versus 5% of controls (P < 0.001), whereas minor complications occurred in 17% and 6%, respectively (P < 0.03). Hematoma, thrombosis, and device-related complications, including elevated defibrillation thresholds, were more common in patients with ESRD (P < 0.05 for all), and there also was a nonsignificant trend toward greater infection risk (P = 0.1). There were no fatal complications in either group.
  
  
  CONCLUSIONS
  Patients with ESRD had greater complication rates after CRMD implantation compared with matched controls, but these complications did not result in death. These results should be considered when evaluating patients with ESRD for prophylactic CRMD implantation, but do not support withholding such therapy.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Arijit
authors.initials: A
authors.lastname: Dasgupta
authors.forename: Jessica
authors.initials: J
authors.lastname: Montalvo
authors.forename: Sara
authors.initials: S
authors.lastname: Medendorp
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Cybele
authors.initials: C
authors.lastname: Ghossein
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldberger
authors.forename: Rod
authors.initials: R
authors.lastname: Passman
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D019468:Disease Management; D004868:Equipment Failure; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies