Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population

Alexander Marschall; Hugo Del Castillo Carnevalli; José Carlos De la Flor Merino; Miguel Rubio Alonso; Ramón De Miguel Gómez; Jorge Palazuelos Molinero; María de Fatima Goncalves Sánchez; Edurne López Soberon; Concepción Fernández Pascual; Ricardo Concepción Suárez; Dámaris Carballeira Puentes; Freddy Andrés Delgado Calva; Salvador Álvarez Antón; David Martí Sánchez

doi:10.1016/j.ijcha.2020.100594

Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population

Int J Cardiol Heart Vasc. 2020 Jul 25:30:100594. doi: 10.1016/j.ijcha.2020.100594. eCollection 2020 Oct.

Authors

Alexander Marschall¹, Hugo Del Castillo Carnevalli¹, José Carlos De la Flor Merino², Miguel Rubio Alonso³, Ramón De Miguel Gómez³, Jorge Palazuelos Molinero¹, María de Fatima Goncalves Sánchez¹, Edurne López Soberon¹, Concepción Fernández Pascual¹, Ricardo Concepción Suárez¹, Dámaris Carballeira Puentes¹, Freddy Andrés Delgado Calva¹, Salvador Álvarez Antón¹, David Martí Sánchez¹

Affiliations

¹ Department of Cardiology, Central defense hospital, Madrid, Spain.
² Department of Nephrology, Central defense hospital, Madrid, Spain.
³ Department of Cardiac Surgery, Central defense hospital, Madrid, Spain.

Abstract

Background: Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI.

Objectives: To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality.

Methods: Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center.

Results: 60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI).

Conclusions: AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.

Keywords: Acute kidney injury; Cardiac resynchronization therapy; Incidence; Predictors.