Incidence and Outcomes of Cardiovascular Implantable Electronic Device Infections in Patients with End-Stage Kidney Disease.

Background: End-stage kidney disease (ESKD) patients are prone to bloodstream infections which may result in a higher risk of cardiac implantable electronic device (CIED) infections.

Objective: To assess the incidence, risk predictors, management strategies and long-term outcomes of CIED infections in ESKD patients undergoing de-novo CIED implantation.

Methods: This is a retrospective study utilizing the United States Renal Data System. ESKD patients with de-novo CIED implant between 1/1/2006-9/30/2014 were included. Patients were followed until death, kidney transplantation, end of Medicare coverage or 9/30/2015 to assess incidence of CIED infection. Management approach was determined from procedure codes for lead extraction within 60 days of CIED infection diagnosis. Patients with CIED infection were followed until 12/31/2019 to assess long-term outcomes.

Results: Among 15,515 ESKD patients undergoing de-novo CIED implant, incidence of CIED infection was 4.8% over a median follow-up of 1.3 years. The presence of a defibrillator (aHR 1.48), higher BMI (aHR 1.01), younger age (aHR 0.96) were independent risk factors for CIED infection. Lead extraction occurred in only 50.71% patients by 60 days. After propensity score matching, the 3-year mortality was higher in those who did not undergo lead extraction compared to those who did (80.3% vs 72.3%) and time to mortality was shorter (0.3 vs 0.6 years). Only 13.8% patients underwent reimplantation with a new CIED after lead extraction.

Conclusion: CIED infections occur frequently in ESKD patients and are associated with a very high mortality. Early lead extraction is not performed routinely but is associated with improved survival.