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Cardiovascular Implantable Electronic Devices in Hemodialysis Patients: Prevalence and Implications for Arteriovenous Hemodialysis Access Interventions
Author(s) -
Saad Theodore F.,
Ahmed Waqas,
Davis Karen,
Jurkovitz Claudine
Publication year - 2014
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12249
Subject(s) - medicine , hemodialysis , psychological intervention , subclavian vein , hemodialysis access , angioplasty , cardiology , vascular access , implantable cardioverter defibrillator , stenosis , surgery , catheter , nursing
Cardiovascular implantable electronic devices ( CIED s) are frequently utilized in hemodialysis patients. CIED leads are typically implanted via the subclavian vein resulting in stenosis and venous hypertension. We studied 1235 chronic hemodialysis patients under the care of our nephrology practice. For each, we determined the presence of a CIED , indication for implantable cardioverter‐defibrillator ( ICD ), and type of hemodialysis access. Records were reviewed to identify all interventions performed on the access circuit and the central veins specifically. A CIED was present in 129 patients (10.5%), including ICD s in 75 (6.1%) and pacemakers in 54 (4.4%). The access circuit intervention rate was 1.48/access year ( AY ) and was similar when a CIED was ipsilateral (1.53/ AY ) or contralateral (1.44/ AY ) to arteriovenous access ( p = 0.477). The rate of central venous interventions was greater in the ipsilateral (0.59/ AY ) versus contralateral group (0.28/ AY ), ( p < 0.001). Fifty‐four of 59 patients with ipsilateral access and CIED required <2 interventions per AY , but six failed angioplasty and required access ligation. None had superior vena cava stenosis requiring intervention. We conclude that there is a high prevalence of CIED s in our HD patients. Ipsilateral CIED and arteriovenous access results in higher central venous intervention rates compared with contralateral cases; overall access circuit intervention rates are similar.