Outcomes of device extraction in patients with chronic kidney disease on renal replacement therapy and cardiac implantable electronic device infections

Abstract

Background: Patients with chronic kidney disease (CKD) on renal replacement therapy (RRT) are at high risk for cardiovascular implantable electronic device (CIED) infections. Although device extraction is standard management, it is often avoided in these patients because of high procedural risks. Objectives: Evaluate the outcomes of CIED extraction in CKD on RRT patients with device infection. Methods: This study used data from the TriNetX research network. The International Classification of Diseases–10th Revision—Clinical Modification coding system was used to identify patients. Adults with a history of CKD on RRT and CIED infection were included. Patients with renal transplantation and prosthetic heart valves were excluded. Patients were stratified by device extraction. The primary outcome was mortality at 1 year. Results: A total of 530 patients were identified, of whom 30% (n = 159) underwent device extraction. After propensity score matching (PSM), 302 patients remained, with 151 in each group. Kaplan-Meier survival analysis demonstrated a significant 1-year survival benefit for patients in the device extraction group (59.2%) compared with the no-extraction group (48.8%, P = .043; hazard ratio [HR], 0.696; 95% confidence interval [CI], 0.489–0.991). Freedom from complications such as pericardial effusion was similar between groups. Sensitivity analysis using Cox proportional hazards, adjusted for baseline confounders, confirmed the survival benefit of extraction, with a reduced mortality risk (HR, 0.581; 95% CI, 0.382-0.883; P = .011). Conclusion: In CKD on RRT patients with CIED infection, device extraction is associated with a reduction in all-cause mortality at 1 year. However, the rate of device extraction is low in this group.