Cardiac Device Therapy in US Patients with Chronic Kidney Disease: Current Outcomes, Complications, and National Trends
DOI:
https://doi.org/10.60087/jklst.vol4.n4.017摘要
Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with high cardiovascular morbidity. Cardiac device therapy, including pacemakers, CRT, leadless pacemakers, and LVADs, is increasingly used, yet real-world outcomes, complications, and trends in these renal populations remain incompletely characterized. Aims: To analyze outcomes, procedural complications, and national trends of cardiac device therapy in US CKD and ESRD patients. Methods: Data were extracted from 16 published studies and national registries, aggregated, and analyzed using Python (VS Code), SPSS v27. Patient demographics, comorbidities, procedural complications, mortality, and hospital utilization were summarized with descriptive statistics. Categorical variables were reported as frequencies/percentages, and continuous variables as means/ranges. Comparative analyses assessed differences between CKD and ESRD across device types. Results: Among 29,005 patients, 5,245 had CKD (stages 3–5) and 3,790 had ESRD. ESRD patients exhibited higher procedural complications: infections (12% vs 7%), bleeding (8% vs 6%), lead dislodgement (5% vs 3%), central vein stenosis (15% vs 10%), and peripheral vascular complications (13% vs 7%). Mortality was higher in ESRD, with inpatient rates 14% versus 6.4% in CKD, and 1-year mortality 50% versus 31%. LVAD recipients had the highest risk, while CRT and leadless pacemakers showed reduced complication rates in selected populations. Hospital cost and length of stay were also elevated in ESRD. Conclusion: ESRD patients experience higher complications, mortality, and hospital utilization than CKD patients. These findings inform risk assessment, device selection, and future clinical strategies.
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