Abstract 14907: Trends in Management Practices of Cardiovascular Implantable Electronic Device Infections in Patients With End-Stage Kidney Disease

Introduction: End-stage kidney disease (ESKD) patients with cardiovascular implantable electronic devices (CIEDs) are at higher risk of bloodstream infection. While prior studies have shown high procedural success rates of lead extraction and improved outcomes, the rates of lead extraction in these patients at the national level are not known.

Aim: To evaluate trends in management practices of CIED infections in ESKD patients.

Methods: Utilizing the United States Renal Data System and ICD 9 codes, we identified patients aged >18 years with ESKD on hemodialysis who underwent first CIED implant from January 2006-September 2014. For study purposes we studied management strategy in those who developed CIED infection within 1 year of device implant. We excluded patients with a prosthetic valve as the ICD 9 code for CIED infection also includes prosthetic valve infection. We restricted the study population to those with CIED implanted until September 2014 as ICD 10 codes were implemented in September 2015 and the ICD 10 code is not specific code for CIED infection (it also includes vascular device infections). After identifying patients diagnosed with CIED infection, we utilized procedure codes for lead extraction within 60 days of the infection diagnosis to determine the mode of management. In the absence of procedure codes for extraction, patients were presumed to have been managed medically.

Results: A total of 380 ESKD patients undergoing CIED implant from 2006-2014 were diagnosed with CIED infections within 1 year of device implant. Of these, 183 (48.16%) patients underwent lead extraction within 60 days. When analyzed by year, the rates of utilization of lead extraction in these patients have not changed significantly from 2006 to 2015 (Table).

Conclusions: The utilization of lead extraction for management of CIED infections in ESKD patients remains low (~50%). This data calls for a reassessment of management strategy for device infections in ESKD patients.