Use of cardiac resynchronization therapy with defibrillator (CRT-D) resulted in lower risk of hospitalization for heart failure or death than use of only an implantable cardioverter-defibrillator (ICD) in patients with moderate-to-severe chronic kidney disease, according to a study published online ahead of print December 15 in the Journal of the American College of Cardiology. The study findings may be independent of kidney function, however. 


Lead author Daniel J. Friedman, MD, and fellow investigators studied 10,946 patients with chronic kidney disease (stage 3-5) who were eligible for an ICD (n = 1,421), which is implanted in the chest and provides an electric shock when it detects life-threatening abnormal heartbeats, or CRT-D (n = 9,525), which can pace both ventricles simultaneously in addition to delivering a shock. Of the eligible group, 87% received CRT-D. 


Researchers found a 15% to 20% reduction in the risk of hospitalization for or death from heart failure in patients who received CRT-D, compared with those who received an ICD. This finding remained even after adjusting for age, sex, severity of chronic kidney disease, and presence of atrial fibrillation or flutter. 



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“Taken in sum, the results from this study support the use of CRT, independent of kidney function. These results, however, should be confirmed by prospective randomized studies,” Dr. Friedman said.