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Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta‐analysis
Author(s) -
Liu Ying,
Sun JinYu,
Zhu YuShan,
Li ZiMeng,
Li KuLin,
Wang RuXing
Publication year - 2020
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.12937
Subject(s) - medicine , odds ratio , cardiac resynchronization therapy , confidence interval , dialysis , cochrane library , kidney disease , meta analysis , heart failure , implantable cardioverter defibrillator , cardiology , ejection fraction
Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure‐specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta‐analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all‐cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty‐six studies ( n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD‐only, CRT(D) was associated with lower risk of all‐cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non‐primary prevention (secondary prevention or both), the analysis revealed a lower risk of all‐cause mortality in the ICD group than in the no‐ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all‐cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30‐59 ml/min/1.73 m 2 ), CKD4/5 (eGFR <30 ml/min/1.73 m 2 ) was observed to have a significantly higher risk of all‐cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all‐cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.