Chronic kidney disease patients can lower heart failure risks with cardiac resynchronization therapy

Chronic kidney disease patients can lower heart failure risks with cardiac resynchronization therapy. Outcomes were greater for chronic kidney disease patients who received cardiac resynchronization therapy with defibrillator, compared to those who only received an implantable cardioverter defibrillator.

An implantable cardioverter defibrillator is implanted in the chest and detects abnormal heart rhythms, which could potentially be fatal. When an abnormal heart rhythm is detected, the defibrillator sends out an electrical shock in order to restore a normal rhythm. Cardiac resynchronization therapy with defibrillator works in a similar manner, but along with administering an electrical shock it also paces both ventricles at the same time.

The researchers used data from the National Cardiovascular Data Registry ICD Registry and examined records of 10,628 patients with kidney disease eligible for either cardiac device. Of the group, 87 percent received cardiac resynchronization therapy with defibrillator.

After adjusting for contributing risk factors, the researchers found that those who received cardiac resynchronization therapy with defibrillator had a 15 to 20 percent lower risk of heart failure hospitalization or death, compared to those with an implanted cardioverter defibrillator.

Study author Daniel J. Friedman said, “Taken in sum, the results from this study support the use of cardiac resynchronization therapy independent of kidney function. The treatment is associated with a reduction in risk of heart failure hospitalization and mortality. These results, however, should be confirmed by prospective randomized studies.”

In an accompanying editorial, John G.F. Cleland, professor of medicine at the National Heart and Lung Institute in London, added, “Within three years, 61 percent of those with end-stage kidney disease who received an implantable cardiac defibrillator and 54 percent who received cardiac resynchronization therapy with defibrillator had died. [It may be better to not] implant, at some risk and discomfort, an expensive piece of technology, which may be attended by substantial morbidity [and instead] have a frank discussion with the patient about the limits of modern medicine.”

Kidney disease patients can benefit from cardiac resynchronization therapy: Previous study

A previous study also found that kidney disease patients can benefit from cardiac resynchronization therapy. Prevalence of congestive heart failure is much higher in patients with kidney disease, compared to individuals without the condition. Unfortunately, despite the higher incidence, chronic kidney disease patients often don’t receive the appropriate treatment for congestive heart failure due to lack of established treatment guidelines, physician’s lack of familiarity in treating both congestive heart failure and chronic kidney disease, and an increased risk of negative side effects.

Cardiac resynchronization therapy with defibrillator has been shown to be successful in treating congestive heart failure in chronic kidney disease patients. This treatment has been shown to improve cardiac structure and function from reverse remodeling in those with both systolic and diastolic congestive heart failure.

For the review, the researchers looked at 18 studies that fit the criteria. Among randomized controlled trials, cardiac resynchronization therapy was found to improve survival rates in chronic kidney disease. Cardiac resynchronization therapy was also associated with improved kidney function in mild chronic kidney disease, but due to its cost additional research is required to determine if it is a cost-effective mode of treatment.