Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta‐analysis. Issue 1 (9th December 2020)

• Record Type: Journal Article
• Authors: Liu, Ying; Sun, Jin‐Yu; Zhu, Yu‐Shan; Li, Zi‐Meng; Li, Ku‐Lin; Wang, Ru‐Xing
• Is Part Of: Seminars in dialysis. Volume 34:Issue 1(2021)
• Page Start: 17
• Page End: 30
• Publication Date: 2020-12-09
• Subjects: all‐cause mortality -- cardiac resynchronization therapy‐defibrillator -- dialysis -- implantable cardioverter defibrillator -- meta‐analysis -- renal insufficiency; Hemodialysis -- Periodicals; Dialysis -- Periodicals; Renal Dialysis -- Periodicals; 617.461059
• DOI: 10.1111/sdi.12937
• Languages: English
• ISSNs: 0894-0959

Abstract

Abstract: Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure‐specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta‐analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all‐cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty‐six studies ( n = 119, 263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD‐only, CRT(D) was associated with lower risk of all‐cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non‐primary prevention (secondary prevention or both), the analysis revealed a lower risk of all‐cause mortality in the ICD group than in the no‐ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all‐cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30‐59 ml/min/1.73 m 2 ), CKD4/5 (eGFR <30 ml/min/1.73 m 2 ) was observed to have a significantly higher risk of all‐cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all‐cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.