Association of Chronic Kidney Disease and End-Stage Renal Disease with Procedural Complications and Inpatient Outcomes of Leadless Pacemaker Implantations Across the United States

Background Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited. Objective To evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations. Methods National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify CKD and ESRD patients who underwent leadless pacemaker implantations in the U.S. from 2016−2020. Study endpoints assessed included inpatient complications, outcomes and resource utilization of leadless pacemaker implantations. Results A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n=5,245, 18.1%) and ESRD (n=3,790, 13.1%) were younger and had higher prevalence of important comorbidities than patients without CKD. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (aOR 1.62, 95% CI 1.40 – 1.86; aOR 1.38, 95% CI 1.18 – 1.63) and prolonged length of stay (aOR 1.55, 95% CI 1.46 – 1.66; aOR 1.81, 95% CI 1.67 – 1.96). ESRD was also associated with higher hospitalization costs (aOR 1.63, 95% CI 1.50 – 1.77) and major complications (aOR 1.62, 95% CI 1.40 – 1.86) after leadless pacemaker implantation. Conclusions Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay, and inpatient mortality.