Chronic kidney disease and implantable cardioverter defibrillator related complications: 16 years of experience.
BACKGROUND
Implantable cardioverter defibrillator (ICD) implantation has become an accepted therapy for the prevention of sudden cardiac death. However, serious comorbidities such as chronic kidney disease (CKD) are influencing the beneficial effects of ICD therapy. In this study, the association between kidney function and the occurrence of ICD related complications was assessed.


METHODS
All patients receiving an ICD or cardiac resynchronization therapy-defibrillator between 1996 and 2012 were included. Renal function was categorized as: glomerular filtration rate (GFR) >90, GFR 30-90 or GFR <30 mL/min/1.73 m(2) . Registered complications were pocket hematoma, pneumothorax, lead complications, and device infection.


RESULTS
In 3,147 device recipients, 236 patients (7.5%) suffered from at least 1 complication. Patients with a GFR <30 (n = 110) had a higher event rate for hematoma, pneumothorax, and infection. These patients were older, had a higher incidence of hypertension, diabetes, and a lower body mass index (BMI; P < 0.05). After correcting for these risk factors, hematoma remained independently associated with a GFR <30 mL/min (OR 2.7, CI: 1.05-6.9, P = 0.04). Device infection, pneumothorax, and lead complications were not independently associated with a GFR <30 mL/min/1.73 m(2) .


CONCLUSIONS
Patients with CKD suffered from more ICD related complications than patients without kidney disease. This was partially associated with kidney dysfunction itself as was the case with the occurrence of hematoma. However, the high burden of risk factors associated with device complications in patients with renal disease played an important role as well.
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Maurits S
MS
Buiten
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Mihály K
MK
DE Bie
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Aafke C
AC
VAN DER Heijden
Department of Nephrology, LUMC, The Netherlands.
Joris I
JI
Rotmans
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Marianne
M
Bootsma
Department of Nephrology, MCH, Den Haag, The Netherlands.
J H
JH
Marc Groeneveld
Department of Medical Statistics, LUMC, Leiden, The Netherlands.
Ron
R
Wolterbeek
Department of Nephrology, LUMC, The Netherlands.
Ton J
TJ
Rabelink
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
J Wouter
JW
Jukema
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Lieselot
L
VAN Erven
D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chronic kidney disease; complications; hematoma; implantable cardioverter defibrillator; infection