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Predictors of renal replacement therapy in patients with continuous flow left ventricular assist devices

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  • Artificial Heart (Clinical)
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Abstract

Renal replacement therapy (RRT) after continuous flow left ventricular assist device (CF-LVAD) implantation significantly affects patients’ quality of life and survival. To identify preoperative prognostic markers in patients requiring RRT after CF-LVAD implantation, we retrospectively reviewed data from patients who underwent implantation of a CF-LVAD at our institution during 2012–2017. Patients who required preoperative RRT were excluded. Preoperative and operative characteristics, as well as survival and adverse events, were compared between 74 (22.2%) patients requiring any duration of postoperative RRT and 259 (77.8%) not requiring RRT. Patients requiring RRT experienced more postoperative complications than patients who did not, including respiratory failure necessitating tracheostomy (35.7% vs 2.5%, p < 0.001), reoperation for bleeding (34.3% vs 11.7%, p < 0.001), and right heart failure necessitating perioperative mechanical circulatory support (32.4% vs 6.9%, p < 0.001). Patients requiring postoperative RRT also had poorer survival at 30 days (74.7% vs 98.8%), 6 months (48.2% vs 95.1%), and 12 months (45.3% vs 90.2%) (p < 0.001). Significant predictors of RRT after CF-LVAD implantation included urine proteinuria (odds ratio [OR] 3.6, 95% confidence interval [CI] [1.7–7.6], p = 0.001), estimated glomerular filtration rate < 45 mL/min/1.73 m2 (OR 3.4, 95% CI [1.5–17.8], p = 0.004), and mean right atrial pressure to pulmonary capillary wedge pressure ratio ≥ 0.54 (OR 2.6, 95% CI [1.3–5.], p = 0.01). Of the 74 RRT patients, 11 (14.9%) recovered renal function before discharge, 36 (48.6%) still required RRT after discharge, and 27 (36.5%) died before discharge. We conclude that preoperative renal and right ventricular dysfunction significantly predict postoperative renal failure and mortality after CF-LVAD implantation.

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Authors and Affiliations

  1. Division of Cardiothoracic Transplantation and Circulatory Support and Division of Cardiology, Baylor College of Medicine, 6720 Bertner Ave, Houston, TX, 77030, USA

    Umang Parikh, Harveen Lamba, Muhammad Ajmal, Justin Vincent, Carl Walther, Alexis Shafii, Ajith Nair, Andrew Civitello, Kenneth Liao & Subhasis Chatterjee

  2. Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA

    Andrew Civitello & Subhasis Chatterjee

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  1. Umang Parikh
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  2. Harveen Lamba
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  3. Muhammad Ajmal
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  4. Justin Vincent
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  5. Carl Walther
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  6. Alexis Shafii
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  7. Ajith Nair
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  8. Andrew Civitello
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  9. Kenneth Liao
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  10. Subhasis Chatterjee
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Correspondence to Harveen Lamba.

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This manuscript is based on a poster presentation with the same title at the American Society of Artificial Internal Organs on June 29th, 2019 in San Francisco, CA.

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Parikh, U., Lamba, H., Ajmal, M. et al. Predictors of renal replacement therapy in patients with continuous flow left ventricular assist devices. J Artif Organs 24, 207–216 (2021). https://doi.org/10.1007/s10047-020-01239-z

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  • DOI: https://doi.org/10.1007/s10047-020-01239-z

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