The Association Between Chronic Kidney Disease and Third-Degree Atrioventricular Block: A Danish Nationwide Study

Background: Chronic kidney disease (CKD) is frequently complicated by arrhythmias, plausibly leading to the increased risk of sudden cardiac death in this population. However, little is known about the association between CKD and third-degree atrioventricular block (3AVB) and need for permanent pacing. Objectives: This study aimed to investigate the association between CKD and 3AVB. Methods: In a population-based nested case-control study, patients with 3AVB were identified between July 1995 and December 2018 using Danish administrative registries. Cases were risk set matched 1:5 with controls on sex and birth year. Multivariable Cox regression was used to analyze the association between CKD and 3AVB, with subsequent logistic regression analyses for computation of odds ratios for pacemaker implantation stratified by dialysis or nondialysis CKD. Results: A total of 31,301 patients with 3AVB were identified and matched with 155,506 controls. The mean age was 74.7 ± 12 years, and 40.2% were female. A significant association was found between CKD and 3AVB after adjustment for comorbidities and potential atrioventricular node blocking agents (HR: 1.83; 95% CI: 1.73-1.93). In stratified analyses, the association was stronger in patients using dialysis compared with nondialysis patients (HR: 7.71; 95% CI: 5.84-10.18; vs HR: 1.73; 95% CI: 1.64-1.83). The odds of pacemaker implantation were lower for patients using dialysis (OR: 0.77; 95% CI: 0.60-0.98) but comparable between patients with nondialysis CKD (OR: 1.04; 95% CI: 0.96-1.12) and patients without CKD. Conclusions: CKD was independently associated with a higher rate of 3AVB, especially for patients using dialysis.