Abstract 279: Mortality Rate in Patients on Hemodialysis with and without Infected Implantable Cardiac Devices Undergoing Extraction

Background: Due to a high frequency of concomitant cardiac disease, many patients with end-stage renal disease on hemodialysis (HD) have indications for cardiac implantable electronic devices (CIED). Patients on HD have increased morbidity and mortality compared to the general population. Additionally, there is increased risk for infection. Limited outcomes data exist for HD patients undergoing transvenous lead extraction (TLE). We sought to compare the mortality rates following TLE in HD patients vs. patients not on HD undergoing TLE. We also compared the mortality rates between these two groups when the indication for extraction was infection (pocket infection or endocarditis). Methods: We conducted a retrospective cohort study including patients on HD who underwent TLE between August 1996 and December 2009. Mortality rates were obtained using the Social Security Death Index and were compared to mortality rates of patients not on HD undergoing TLE during this same time period. Results: The study population included 63 patients (median age 70.0, IQR 18.3) on HD at the time of TLE. The control population included 2557 patients (median age 67,2, IQR 20.0 ) that underwent TLE during the same time period. Procedural mortality rate was 0.002% in the control group and 0% in the HD group. Mortality at 30 days, 1 year, and 3 years was significantly higher in HD patients (23.8%, 54.0% and 92.1%) compared to non HD patients (1.91%, 10.24%, and 20.41%). In the HD group, patients with pocket infection or infective endocarditis had higher mortality rates at 30 days, 1 year, and 3 years (27.45%, 60.78%, and 92.15%) than patients undergoing TLE due to infection but not on hemodialysis (2.9%, 13.28% and 25.55%). (Table 1) Conclusions: Despite equivalent and very low procedural mortality rates in patient on HD compared to control, subsequent mortality rates in patients on HD at the time of TLE far exceeds the mortality rate after TLE in patients not on HD. Mortality rates are elevated even further in patients on HD that undergo TLE for infection.