Predictors and Outcomes of Renal Replacement Therapy After Left Ventricular Assist Device Implantation

Asleh, Rabea; Schettle, Sarah; Briasoulis, Αlexandros; Killian, Jill M.; Stulak, John M.; Pereira, Naveen L.; Kushwaha, Sudhir S.; Maltais, Simon; Dunlay, Shannon M.

doi:10.1016/j.mayocp.2018.09.021

Cited by 14 publications

(21 citation statements)

References 33 publications

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“…It has also been shown by Muslem et al that pre-operative proteinuria before LVADs implantation is associated with mortality and hemodialysis at one year [11]. Furthermore, the need of hemodialysis after LVADs implantation is associated with an increased risk of mortality, underlying the impact of renal function in LVADs patients survival [12]. In the present study, we hypothesized that subclinical hemolysis induced by LVADs is a cause of tubular injury and associated with subsequent decrease in kidney function.…”

Section: Introductionmentioning

confidence: 67%

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

et al. 2020

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Background Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. Methods Thirty-three patients implanted with a Heartmate II LVAD (Abbott, Inc, Chicago IL) were retrospectively studied. Hemolysis, Acute Kidney Injury (AKI) and the evolution of estimated Glomerular Filtration Rate were analyzed. Proximal Tubulopathy (PT) groups were defined according to proteinuria, normoglycemic glycosuria, and electrolytic disorders. The Receiver Operating Characteristic (ROC) curve was used to analyze threshold of LDH values associated with PT. Results Median LDH between PT groups were statistically different, 688 IU/L [642–703] and 356 IU/L [320–494] in the “PT” and “no PT” groups, respectively p = 0.006. To determine PT group, LDH threshold > 600 IU/L was associated with a sensitivity of 85.7% (95% CI, 42.1–99.6) and a specificity of 84.6% (95% CI, 65.1–95.6). The ROC's Area Under Curve was 0.83 (95% CI, 0.68–0.98). In the “PT” group, patients had 4.2 [2.5–5.0] AKI episodes per year of exposure, versus 1.6 [0.4–3.7] in the “no PT” group, p = 0.03. A higher occurrence of AKI was associated with subsequent development of Chronic Kidney Disease (CKD) (p = 0.02) and death (p = 0.05). Conclusions LVADs-induced subclinical hemolysis is associated with proximal tubular functional alterations, which in turn contribute to the occurrence of AKI and subsequent CKD. Owing to renal toxicity of hemolysis, measures to reduce subclinical hemolysis intensity as canula position or pump parameters should be systematically considered, as well as specific nephroprotective therapies.

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Section: Introductionmentioning

confidence: 67%

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

et al. 2020

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“…Asleh et al [ 30 ] reported among patients requiring KRT after LVAD placement, one-third had kidney recovery, one-third required outpatient hemodialysis, and one-third of the patients died before hospital discharge. In study by Borgi et al [ 7 ] patients with post LVAD AKI were more likely to suffer longer hospital stay (32.4 vs 18.7; P = 0.05), right ventricular (RV) failure (25% vs 5.6%; P = 0.01) and a higher mortality rate as compared to non-AKI groups at 30-day (17.9% vs 0%; P < 0.001), 180-day (28.6% vs 2.8%; P < 0.001), and 360- day (28.6% vs 6.9%; P = 0.012), respectively.…”

Section: Resultsmentioning

confidence: 99%

Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A meta-analysis

Kovvuru¹,

Kanduri²,

Vallabhajosyula³

et al. 2021

WJCCM

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BACKGROUND Acute kidney injury (AKI) is a common and severe complication after left ventricular assist device (LVAD) implantation with an incidence of 37%; 13% of which require kidney replacement therapy (KRT). Severe AKI requiring KRT (AKI-KRT) in LVAD patients is associated with high short and long-term mortality compared with AKI without KRT. While kidney function recovery is associated with better outcomes, its incidence is unclear among LVAD patients with severe AKI requiring KRT. AIM To identify studies evaluating the recovery rates from severe AKI-KRT after LVAD placement, which is defined by regained kidney function resulting in the discontinuation of KRT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies. METHODS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate ( P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses. RESULTS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate ( P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses. CONCLUSION Recovery from severe AKI-KRT after LVAD occurs approximately 50.5%, and it has not significantly changed over the years despite advances in medicine.

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“… 17 In addition, Asleh et al examined use of renal replacement therapy (RRT) in a study of 354 patients who underwent LVAD implantation between 2007–2017. 18 Of these patients, 15% required in-hospital RRT following LVAD implantation. 18 Characteristics of these patients included higher preoperative Charlson Comorbidity Index values, higher Model for End-Stage Liver Disease scores, higher right atrial pressure, higher estimated 24-hour urine protein levels, and lower preoperative estimated GFR and measured GFR using 125 I-iothalamate clearance when compared to those who did not require RRT.…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

“… 18 Of these patients, 15% required in-hospital RRT following LVAD implantation. 18 Characteristics of these patients included higher preoperative Charlson Comorbidity Index values, higher Model for End-Stage Liver Disease scores, higher right atrial pressure, higher estimated 24-hour urine protein levels, and lower preoperative estimated GFR and measured GFR using 125 I-iothalamate clearance when compared to those who did not require RRT. 18 Of the patients requiring in-hospital RRT, 33% had renal recovery, 33% required outpatient hemodialysis, and 33% died before hospital discharge.…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

“… 18 Characteristics of these patients included higher preoperative Charlson Comorbidity Index values, higher Model for End-Stage Liver Disease scores, higher right atrial pressure, higher estimated 24-hour urine protein levels, and lower preoperative estimated GFR and measured GFR using 125 I-iothalamate clearance when compared to those who did not require RRT. 18 Of the patients requiring in-hospital RRT, 33% had renal recovery, 33% required outpatient hemodialysis, and 33% died before hospital discharge. 18 The study further concluded that higher preoperative creatinine levels, higher 24-hour urine protein levels, and higher mean right atrial pressure and longer cardiopulmonary bypass time were independent predictors of RRT after LVAD.…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

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Renal Dysfunction in Patients with Left Ventricular Assist Device

Nihum¹,

Manian²,

Arunachalam³

et al. 2022

Methodist DeBakey Cardiovascular Journal

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Late-stage heart failure and renal dysfunction are often seen in conjunction. Cardiorenal syndrome (CRS) describes the complex interaction between the two disease states. Early literature described the pathophysiology of CRS as related only to reduced cardiac output and decreased renal perfusion. Recent literature suggests a more multifaceted mechanism. Left ventricular assist devices (LVAD), used as bridge-to-transplant and destination therapy in patients with heart failure, impact not only cardiac function but also renal function, especially in those patients with preoperative renal dysfunction. The mechanism by which LVAD implantation affects renal function is complex and understated in early literature. In this review, we discuss the pathogenesis of CRS, the impact of preoperative renal dysfunction in patients undergoing LVAD implantation, and the effect of LVAD implantation on postoperative renal function.

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Predictors and Outcomes of Renal Replacement Therapy After Left Ventricular Assist Device Implantation

Cited by 14 publications

References 33 publications

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A meta-analysis

Renal Dysfunction in Patients with Left Ventricular Assist Device

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