title: Cardiac Resynchronization Therapy prevents progression of renal failure in heart failure patients.
abstract: BACKGROUND
  The goal of this study is to assess the effect of cardiac resynchronization therapy (CRT) over time on renal function and its impact on mortality. The effect of CRT on renal function in patients with heart failure is not well understood.
  
  
  METHODS
  All patients who underwent CRT implantation at University of Kansas between year 2000 and 2009 were reviewed and patients who had pre and post CRT renal function studied were included in our study. Stages of chronic kidney disease (CKD) were defined based on Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. The effect of CRT on renal and cardiac function were studied at short term (≤6 months post implantation) and long term (>6 months).
  
  
  RESULTS
  A total of 588 patients with mean age of 67 ± 12 yrs were included in the study. CRT responders (defined by increase in LVEF ≥ 5%) were 54% during short term follow-up and 65% on long term follow-up. When compared to baseline, there was no significant deterioration in mean Glomerular Filtration Rate (GFR) during follow up. When analyzed based on the stages of CKD, there was significant improvement of renal function in patients with advanced kidney disease. Multivariate logistic regression analysis showed that stable GFR or an improvement in GFR independently predicted mortality after adjusting for co-morbidities.
  
  
  CONCLUSIONS
  CRT was associated with stabilization of renal function in patients with severe LV dysfunction and improvement in stage 4 and 5 CKD. Improved renal function was associated with a lower mortality.
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Vinodh
authors.initials: V
authors.lastname: Jeevanantham
authors.affiliation: University of Missouri, Columbia, MO, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Turagam
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: David
authors.initials: D
authors.lastname: Shanberg
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Atoui
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
keywords: Cardiac Resynchronization Therapy; Chronic kidney disease; Congestive heart failure; Glomerular filtration rate; Implantable cardioverter defibrillator