Impact of transvenous cardiac implantable electronic devices in chronic hemodialysis patients: a single-center, observational comparative study

BMC Nephrology

Min-Ju Kim¹  Gi Byoung Nam²  Jai Won Chang³  Tae-Won Kwon⁴  Youngjin Han⁴  Yong-Pil Cho⁴  Seonjeong Jeong⁴ 

[1]Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center

[2]Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

[3]Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

[4]Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center

关键词: Artificial pacemaker;    Implantable defibrillators;    Renal dialysis;   

DOI  :  10.1186/s12882-018-1095-y

来源: DOAJ

【 摘 要 】

Abstract Background We investigated the impact of a transvenous cardiac implantable electronic device (CIED) placement on outcomes and arteriovenous vascular access (VA) patency among chronic hemodialysis patients. Methods This is a single-center, observational comparative study between chronic hemodialysis patients with ipsilateral and contralateral CIED and VA. Forty-two consecutive patients who underwent both CIED placement and upper-extremity VA for hemodialysis, regardless of the sequence and time interval between these 2 procedures, were identified between January 2001 and December 2017. Patients with ipsilateral (n = 22, 52%, the ipsilateral group) and contralateral (n = 20, 48%, the contralateral group) CIED and VA were compared retrospectively; the primary outcome was any-cause mortality and cardiac mortality or the composite of any systemic complications, defined as central venous stenosis or occlusion, any device infections or tricuspid regurgitation; the secondary outcome was CIED or VA malfunction. Results During the median follow-up period of 101 months, primary outcome incidence was significantly higher in the ipsilateral group than the contralateral group (73% vs 40%, P = 0.03), although the incidences of any-cause mortality (P = 0.28) and cardiac mortality (P > 0.99) were similar between the groups. Secondary outcome incidence did not differ significantly between the 2 groups (55% vs 30%, P = 0.36). Kaplan–Meier survival analysis revealed similar primary and secondary VA patency rates in both groups. On subgroup analysis, patients with upper arm VA had similar primary and secondary patency to those with forearm VA. Conclusions Despite some notable limitations of the study, the retrospective study design and small sample size, we found that the any-cause mortality incidence and VA patency did not differ between the 2 groups, but primary outcome incidence was significantly higher among patients with ipsilateral CIED and VA.

【 授权许可】

Unknown