Cardiac resynchronization therapy in CKD: A systematic review

Neha Garg, George Thomas, Gregory Jackson, John Rickard, Joseph V. Nally, W. H.Wilson Tang, Sankar D. Navaneethan

Research output: Contribution to journalArticle

Abstract

Background Cardiac resynchronization therapy (CRT) confers morbidity and mortality benefits to selected patients with heart failure. This systematic review examined effects of CRT in CKD patients (estimated GFR [eGFR] <60 ml/min per 1.73 m2). Design, setting, participants, & measurements MEDLINE and Scopus (from 1990 to December 2012) and conference proceedings abstracts were searched for relevant observational studies and randomized controlled trials (RCTs). Studies comparing the following outcomeswere included: (1) CKD patientswith andwithout CRT and (2) CKD patients with CRT to non-CKD patients with CRT. Mortality, eGFR, and left ventricular ejection fraction data were extracted and pooled when appropriate using a random-effects model. Results Eighteen studies (14 observational studies and 4 RCTs)were included. Therewas a modest improvement in eGFR with CRT among CKD patients (mean difference 2.30 ml/min per 1.73m2; 95%confidence interval, 0.33 to 4.27). Similarly, there was a significant improvement in left ventricular ejection with CRT in CKD patients (mean difference 6.24%; 95% confidence interval, 3.46 to 9.07). Subgroup analysis of three RCTs reported lower rates of death or hospitalization for heart failurewith CRT (versus other therapy) in theCKDpopulation. Survival outcomes of CKD patients (compared with the non-CKD population) with CRT differed among observational studies and RCTs. Conclusions CRT improves left ventricular and renal function in theCKDpopulation with heart failure.Given the increasing use of cardiac devices, further studies examining the effects of CRT on mortality in CKD patients, particularly those with advanced kidney disease, are warranted.

Original languageEnglish (US)
Pages (from-to)1293-1303
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number8
DOIs
StatePublished - Jul 1 2013

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Garg, N., Thomas, G., Jackson, G., Rickard, J., Nally, J. V., Tang, W. H. W., & Navaneethan, S. D. (2013). Cardiac resynchronization therapy in CKD: A systematic review. Clinical Journal of the American Society of Nephrology, 8(8), 1293-1303. https://doi.org/10.2215/CJN.00750113