Cardiac Resynchronization Therapy (CRT) in a Patient With With Chronic Kidney Disease, Diabetes and Hypertension
Dr. S. A. Merchant | Advanced Heart Failure Clinic in Mumbai
Patient Profile
| Name | Confidential |
| Age | 50 years |
| Gender | Male |
| Occupation | Police constable |
| Presenting Complaints | Abdominal distension, dyspnea on exertion, fatigue |
| Key Investigation Findings | High creatinine, high HbA1c |
| Diagnosis | Chronic Kidney Disease (CKD), Diabetes Mellitus, Hypertension |
| Treatment | CRT implant (23 March 2026), Guideline-Directed Medical Therapy (GDMT) |
| Outcome | Stable on GDMT |
| Long-Term Plan | Renal diet as advised, to decrease creatinine levels |
The Problem
Condition
The patient, a 50-year-old male working as a police constable, consulted Dr. S. A. Merchant at the Advanced Heart Failure Clinic with abdominal distension, dyspnea on exertion, and fatigue. Dyspnea on exertion refers to breathlessness during physical activity, and abdominal distension refers to swelling or fullness of the abdomen. Both can be associated with fluid retention, and fatigue is a common accompanying symptom.
Laboratory evaluation showed a high serum creatinine and a high HbA1c. These findings, together with the clinical assessment, established diagnoses of Chronic Kidney Disease (CKD), Diabetes Mellitus, and Hypertension. The patient subsequently underwent a CRT implant on 23 March 2026 and is being managed on Guideline-Directed Medical Therapy (GDMT).
Understanding the Findings
Serum creatinine is a waste product filtered by the kidneys. A raised level indicates reduced kidney filtration and is one of the markers used to assess kidney function. HbA1c reflects average blood glucose control over the preceding two to three months, and a high value indicates that glucose levels have remained above target.
Diabetes mellitus and hypertension are both recognized contributors to chronic kidney disease. The heart and kidneys also influence one another, since changes in cardiac function can affect blood flow to the kidneys, and reduced kidney function can affect fluid balance and blood pressure. For this reason, the management of a patient with cardiac symptoms alongside CKD, diabetes, and hypertension requires attention to all three conditions together.
Consultation and Treatment Plan
Why This Approach Was Chosen
Dr. S. A. Merchant advised a CRT implant together with GDMT. This approach addresses the cardiac component of the patient’s condition through device therapy and medication, while the associated kidney, glucose, and blood pressure findings are taken into account in the overall plan.
A renal diet was also advised, with the aim of decreasing creatinine levels. This reflects a general principle in patients with CKD, where dietary measures form part of the long-term management alongside medical treatment.
Procedure Details
Overview
The patient’s management combined a CRT implant with Guideline-Directed Medical Therapy and dietary guidance.
Approach:
Systems addressed:
Associated finding:
Cardiologist:
CRT Implant
Cardiac Resynchronization Therapy (CRT) is a device-based treatment used in selected patients with heart failure. The device is implanted under the skin, with leads placed in the heart, and delivers timed electrical impulses that help the chambers of the heart contract in a more coordinated manner. A coordinated contraction can improve the efficiency with which the heart pumps blood. In this patient, the CRT implant was carried out on 23 March 2026.
Guideline-Directed Medical Therapy
Guideline-Directed Medical Therapy (GDMT) refers to the combination of medications recommended by clinical guidelines for the treatment of heart failure. The aim is to reduce symptoms and the risk of worsening heart failure. In patients with kidney disease, the choice and dose of medication are individualized by the treating cardiologist, since kidney function can influence how medicines are tolerated and cleared from the body. The patient continues on GDMT.
Renal Diet
A renal diet is a dietary plan designed to reduce the load on the kidneys. The specific restrictions differ between patients and depend on the stage of kidney disease, laboratory results, and other conditions such as diabetes and hypertension. For this patient, a renal diet was advised to decrease creatinine levels, and the patient has been counselled to follow it as directed.
Post-Treatment Results
Following the CRT implant and with ongoing GDMT, the patient is stable. His care continues under Dr. S. A. Merchant at the Advanced Heart Failure Clinic.
Current medical therapy
Dietary guidance
Patient satisfaction
Device therapy
Long-term plan
creatinine levels
Long-Term Follow-Up
Long-term management of this patient centres on continued GDMT and adherence to the advised renal diet, with the aim of decreasing creatinine levels. Regular review allows the treating team to monitor cardiac status, kidney function, and glucose and blood pressure control, and to adjust treatment as required.
Patient Feedback
The patient reported being satisfied with his care.
Profile: Male · 50 years · Police constable Management: CRT Implant · Guideline-Directed Medical Therapy · Renal Diet Cardiologist: Dr. S. A. Merchant, Advanced Heart Failure Clinic, Bandra West, Mumbai
Frequently Asked Questions
Q1. What is Cardiac Resynchronization Therapy (CRT)?
Q2. What does Guideline-Directed Medical Therapy (GDMT) mean?
Q3. Why was a renal diet advised for this patient?
Q4. How are heart and kidney conditions related?
Q5. What is the patient's current status?
Q6. Why choose Dr. S. A. Merchant?
Living With Heart Symptoms and Kidney Disease?
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Disclaimer:The information on this page is for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Individual results vary from patient to patient. Always consult a qualified cardiologist regarding any medical condition.