Incidence and outcomes of cardiovascular implantable electronic device infections in patients with end-stage kidney disease

Sania Jiwani; Wan-Chi Chan; Akshaya Gadre; Seth Sheldon; Jinxiang Hu; Rhea Pimentel; Amit Noheria; Kamal Gupta

doi:10.1016/j.hrthm.2024.09.016

Incidence and outcomes of cardiovascular implantable electronic device infections in patients with end-stage kidney disease

Heart Rhythm. 2024 Sep 12:S1547-5271(24)03313-7. doi: 10.1016/j.hrthm.2024.09.016. Online ahead of print.

Authors

Sania Jiwani¹, Wan-Chi Chan¹, Akshaya Gadre¹, Seth Sheldon¹, Jinxiang Hu², Rhea Pimentel¹, Amit Noheria¹, Kamal Gupta³

Affiliations

¹ Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
² Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas.
³ Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: kgupta@kumc.edu.

PMID: 39277069
DOI: 10.1016/j.hrthm.2024.09.016

Abstract

Background: End-stage kidney disease (ESKD) patients are prone to bloodstream infections that may result in a higher risk of cardiac implantable electronic device (CIED) infections.

Objective: The objective of this study was to assess the incidence, risk predictors, management strategies, and long-term outcomes of CIED infections in ESKD patients undergoing de novo CIED implantation.

Methods: This is a retrospective study using the United States Renal Data System. ESKD patients with de novo CIED implantation between January 1, 2006, and September 30, 2014, were included. Patients were observed until death, kidney transplantation, end of Medicare coverage, or September 30, 2015, to assess incidence of CIED infection. Management approach was determined from procedure codes for lead extraction within 60 days of CIED infection diagnosis. Patients with CIED infection were observed until December 31, 2019, to assess long-term outcomes.

Results: Of 15,515 ESKD patients undergoing de novo CIED implantation, incidence of CIED infection was 4.8% during a median follow-up of 1.3 years. The presence of a defibrillator (adjusted hazard ratio [aHR], 1.48), higher body mass index (aHR, 1.01), and younger age (aHR, 0.96) were independent risk factors for CIED infection. Lead extraction occurred in only 50.71% of patients by 60 days. After propensity score matching, the 3-year mortality was higher in those who did not undergo lead extraction compared with those who did (80.3% vs 72.3%) and time to mortality was shorter (0.3 vs 0.6 year). Only 13.8% of patients underwent reimplantation with a new CIED after lead extraction.

Conclusion: CIED infections occur frequently in ESKD patients and are associated with a high mortality. Early lead extraction is not performed routinely but is associated with improved survival.

Keywords: Cardiac implantable electronic device infection; Defibrillator; End-stage kidney disease; Lead extraction; Mortality; Pacemaker; Reimplantation.