Abstract Body (Do not enter title and authors here): Introduction: Patients with end-stage renal disease (ESRD) are prone to cardiovascular implantable electronic device (CIED) infections with a reported 12-month infection rate of 1%, portending an all-cause mortality rate up to 35%. Complete device extraction reduces reinfection and mortality, but is complex and carries high risks, especially for ESRD patients. Here we compare outcomes in infected CIED extraction in the ESRD population.
Methods: This study utilized data from the TriNetX research network. We included adults with a history of ESRD and CIED infection. Patients were stratified by device extraction, and those with a history of renal transplant were excluded. Propensity score matching was performed, with outcomes of interest: mortality, all-cause admission, sepsis or bacteremia, and 30-day complications.

Results: In the ESRD population, we identified 271 patients who underwent extraction for infected CIED and 623 who did not undergo extraction. CIED extraction was associated with improved survival at one year (65.7% vs 57.3%, p=0.047). The survival benefit was evident at 30 days (91.6% vs 85.8%, p=0.03). No appreciable difference in freedom from admission (30.6% vs. 32.1%, p=0.875) or from sepsis or bacteremia (44.9 vs. 44.8%, p=0.130) at one year. At 30 days, there was no difference in development of pericardial effusion or tamponade (95.7% in vs. 98%, p=0.069), respiratory failure (75.9% vs. 73.4%, p=0.529), or red blood cell transfusion (94% vs. 90.1%, p=0.153). In the extraction group, freedom from cardiac surgery at 30 days was 88.1%, with 11.6% of patients requiring open lead extraction.
Conclusion: In ESRD patients with CIED infections, device extraction is associated with a significant reduction in all-cause mortality at one year without increasing the risk of all-cause admission, sepsis or bacteremia, or 30-day complications. These findings support considering device extraction in this high-risk population to improve survival outcomes. Further research is needed to optimize management strategies and address the challenges specific to ESRD patients with CIED infections.