Background <p>Heart failure (HF) and kidney disease commonly coexist and are associated with high mortality, as kidney disease is known to increase the risk of arrhythmias and sudden cardiac death in HF patients. The use of cardiac implantable electronic devices (CIEDs) has proven to be an effective therapy for HF patients. However, the literature on the outcomes of these devices in HF patients with underlying kidney disease is limited, given their exclusion from major trials.</p> Methods <p>Utilizing the National Inpatient Sample (NIS) database, hospitalizations with a discharge diagnosis of HF and CIEDs were identified from 2016 to 2021 and stratified into groups of no kidney disease, chronic kidney disease (CKD), and end-stage renal disease (ESRD). Baseline characteristics were compared, and adjusted outcomes were obtained.</p> Results <p>A total of 24,250 HF patients with CIED were identified and divided into HF group with no kidney disease (<i>n</i> = 14,485), HF-CKD (<i>n</i> = 8990) (37%), and HF-ESRD (<i>n</i> = 775). Compared to patients with HF with no kidney disease, those with CKD and ESRD showed higher odds of in-hospital mortality and cardiogenic shock. Patients with HF and ESRD had higher odds of sudden cardiac arrest and mechanical circulatory support utilization compared to those with no kidney disease.</p> Conclusion <p>Underlying kidney disease is associated with increased mortality and complications in HF patients having CIED implantations. Further prospective studies and trials are needed to help identify the appropriate use of CIED in HF patients with kidney disease.</p> Graphical Abstract <p></p>