title: Cardiac resynchronization therapy in CKD: a systematic review.
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)).
  
  
  METHODS
  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.
authors: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors: Neha
authors: N
authors: Garg
authors: George
authors: G
authors: Thomas
authors: Gregory
authors: G
authors: Jackson
authors: John
authors: J
authors: Rickard
authors: Joseph V
authors: JV
authors: Nally
authors: W H Wilson
authors: WH
authors: Tang
authors: Sankar D
authors: SD
authors: Navaneethan
mesh_terms: D058406:Cardiac Resynchronization Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology*; D012084:Renin-Angiotensin System / Q000502:physiology; D016277:Ventricular Function, Left
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