Rahatullah Muslem1, Kadir Caliskan1, Sakir Akin1, Kavita Sharma2, Nisha A Gilotra2, Alina A Constantinescu1, Brian Houston3, Glenn Whitman2, Ryan J Tedford2, Dennis A Hesselink4, Ad J J C Bogers5, Stuart D Russell2, Olivier C Manintveld6. 1. Thoraxcenter, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 2. Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland, USA. 3. Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA. 4. Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 5. Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands. 6. Thoraxcenter, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: o.manintveld@erasmusmc.nl.
Abstract
BACKGROUND: Data on the consequences of acute kidney injury (AKI) after continuous-flow left ventricle assist device (LVAD) implantation are scarce and inconsistent. In this study, we evaluated the incidence, predictors and the impact of AKI on mortality and renal function in the first year after LVAD implantation. METHODS: A retrospective, multicenter cohort study was conducted, including all patients (age ≥18 years) undergoing LVAD implantation (91% with a HeartMate II device and 9% with a HeartWare device). The definition proposed by the Kidney Disease Improving Global Outcome (KDIGO) criteria was used to define AKI. RESULTS: Overall, 241 patients (mean age 52.4 ± 12.9 years, 76% males) were included in the study. AKI criteria were met in 169 (70%) patients, of whom 109 (45%) were in AKI Stage I, 22 (9%) in Stage II and 38 (16%) in Stage III. Two factors, the need for pre-operative inotropic support and pre-existent chronic kidney disease Stage ≤II (estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m2), were independently associated with the development of AKI and the severity of AKI stages. One-year mortality rates in patients without AKI and AKI Stages I, II and III were 18.7%, 26.4%, 23%, and 51%, respectively (log rank, p = 0.001). In the multivariable analysis, AKI Stage ≥II was independently associated with mortality (hazard ratio 2.2 [95% confidence interval 1.1 to 4.5], p = 0.027) and worse renal function (β = -7.4 [95% confidence interval -12.6 to -2.1], p < 0.01) at 1 year. CONCLUSION: AKI is highly frequent after LVAD implantation. More severe AKI stages are associated with higher mortality rates and impaired renal function at 1 year after LVAD implantation.
BACKGROUND: Data on the consequences of acute kidney injury (AKI) after continuous-flow left ventricle assist device (LVAD) implantation are scarce and inconsistent. In this study, we evaluated the incidence, predictors and the impact of AKI on mortality and renal function in the first year after LVAD implantation. METHODS: A retrospective, multicenter cohort study was conducted, including all patients (age ≥18 years) undergoing LVAD implantation (91% with a HeartMate II device and 9% with a HeartWare device). The definition proposed by the Kidney Disease Improving Global Outcome (KDIGO) criteria was used to define AKI. RESULTS: Overall, 241 patients (mean age 52.4 ± 12.9 years, 76% males) were included in the study. AKI criteria were met in 169 (70%) patients, of whom 109 (45%) were in AKI Stage I, 22 (9%) in Stage II and 38 (16%) in Stage III. Two factors, the need for pre-operative inotropic support and pre-existent chronic kidney disease Stage ≤II (estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m2), were independently associated with the development of AKI and the severity of AKI stages. One-year mortality rates in patients without AKI and AKI Stages I, II and III were 18.7%, 26.4%, 23%, and 51%, respectively (log rank, p = 0.001). In the multivariable analysis, AKI Stage ≥II was independently associated with mortality (hazard ratio 2.2 [95% confidence interval 1.1 to 4.5], p = 0.027) and worse renal function (β = -7.4 [95% confidence interval -12.6 to -2.1], p < 0.01) at 1 year. CONCLUSION: AKI is highly frequent after LVAD implantation. More severe AKI stages are associated with higher mortality rates and impaired renal function at 1 year after LVAD implantation.
Authors: Oliver K Jawitz; Marat Fudim; Vignesh Raman; Vanessa Blumer; Kadir Caliskan; Adam D DeVore; Robert J Mentz; Carmelo Milano; Osama Soliman; Joseph Rogers; Chetan B Patel Journal: Ann Thorac Surg Date: 2020-01-03 Impact factor: 4.330
Authors: J Hunter Mehaffey; Ryan Cantor; Susan Myers; Nicholas R Teman; John A Kern; Gorav Ailawadi; Francis Pagani; James Kirklin; Kenan Yount; Leora Yarboro Journal: JTCVS Open Date: 2022-01-22