Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices

Topkara, V.K.; Coromilas, Ellie J.; Garan, A.R.; Li, Randall C.; Castagna, F.; Jennings, Douglas L.; Yuzefpolskaya, M.; Takeda, Koji; Takayama, Hiroaki; Sladen, Robert N.; Mancini, Donna; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, P.C.

doi:10.1161/circheartfailure.115.002897

Cited by 38 publications

(32 citation statements)

References 29 publications

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“…Kirklin et al [20] reported that increased preoperative renal dysfunction, quantified by blood urea nitrogen and estimated glomerular filtration rate, was associated with increased postoperative mortality, particularly in the first 3 months. We also found, similar to Chertow et al [28], that preoperative serum creatinine was higher in those who developed moderate AKI ( p = 0.045), which subsequently increased the risk of mortality, consistent with the previous literature [20, 25]. This increased preoperative creatinine may be an indicator of baseline renal dysfunction of some degree, though various biomarkers and ratios (such as urine albumin and the urine albumin creatinine ratio) may prove more reliable [28, 29].…”

Section: Discussionsupporting

confidence: 93%

“…Identifying biomarkers that confirm cardiac surgery-associated AKI, such as urine neutrophil gelatinase-associated lipocalin, have been evaluated, but to date the results have been unreliable in predicting clinical outcomes [24]. Recently, preoperative estimated glomerular filtration rate and proteinuria were identified as predictors of postoperative renal dysfunction necessitating renal replacement therapy in continuous-flow LVAD recipients [25]. Recent evidence from a single center showed intravenous inotropic therapy to be noninferior to LVAD placement for end-stage heart failure patients with respect to mortality and the need for renal perfusion [26].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

et al. 2019

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Background: Although acute kidney injury (AKI) is a common complication following cardiac surgery, less is known about the occurrence and consequences of moderate/severe AKI following left ventricular assist device (LVAD) implantation. Methods: All patients who had an LVAD implanted at our center from 2008 to 2016 were reviewed to determine the incidence of, and risk factors for, moderate/severe (stage 2/3) AKI and to compare postoperative complications and mortality rates between those with and those without moderate/severe AKI. Results: Of 246 patients, 68 (28%) developed moderate/severe AKI. A multivariable logistic regression comprising body mass index and prior sternotomy had fair predictive ability (area under the curve = 0.71). A 1-unit increase in body mass index increased the risk of moderate/severe AKI by 7% (odds ratio = 1.07; 95% confidence interval: 1.03–1.11); a prior sternotomy increased the risk more than 3-fold (odds ratio = 3.4; 95% confidence interval: 1.84–6.43). The group of patients with moderate/severe AKI had higher rates of respiratory failure and death than the group of patients with mild/no AKI. Patients with moderate/severe AKI were at 3.2 (95% confidence interval: 1.2–8.2) times the risk of 30-day mortality compared to those without. Even after adjusting for age and Interagency Registry for Mechanically Assisted Circulatory Support profile, those with moderate/severe AKI had 1.75 (95% confidence interval: 1.03–3.0) times the risk of 1-year mortality compared to those without. Discussion: Risk-stratifying patients prior to LVAD placement in regard to AKI development may be a step toward improving surgical outcomes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

et al. 2019

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“…The incidence of postimplantation AKI is 7%-14% in continuous-ow devices [29]. In addition, RRT is needed in a subset of patients who develop post-LVAD AKI [30].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Jiang

Kong

Xue

et al. 2020

Preprint

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Objectives: This study aimed to identify the incidence rate of Acute kidney injury (AKI) in our center and predict in-hospital mortality and long-term survival after heart transplantation (HTx). Methods: This single-center, retrospective study from October 2009 and March 2020 analyzed the pre-, intra-, and postoperative characteristics of 95 patients who underwent HTx. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk factors were analyzed by multivariable logistic regression models. The log-rank test was used to compare long-term survival. Results: : Thirty-three (34.7%) patients developed AKI. The mortality in hospital in HTx patients with and without AKI were 21.21% and 6.45%, respectively (P<0.05). Recipients in AKI who required renal replacement therapy (RRT) had a hospital mortality rate of 43.75% compared to 6.45% in those without AKI or RRT (P<0.0001). A long cardiopulmonary bypass (CPB) time (OR:11.393, 95% CI: 2.183 to 59.465, P=0.0039) was positively related to the occurrence of AKI. A high intraoperative urine volume (OR: 0.031, 95% CI: 0.005 to 0.212, P=0.0004) was negatively correlated with AKI. AKI requiring RRT (OR, 11.348; 95% CI, 2.418-53.267, P=0.002) was a risk factor for mortality in hospital. Overall survival in patients without AKI at 1 and 3 years was not different from that in patients with AKI (P=0.096).Conclusions: AKI is common after HTx. AKI requiring RRT could contribute powerful prognostic information to predict mortality in hospital. A long CPB time and low intraoperative urine volume are associated with the occurrence of AKI.

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“…Kidney failure after left ventricular assist device (LVAD) is an uncommon occurrence 95 . This may be because LVAD therapy is contraindicated in patients at high risk for kidney failure, as it is known that LVAD patients who require dialysis have extremely high mortality (>60%) 96 . In LVAD recipients who develop kidney failure, both PD and hemodialysis can be considered as treatment modalities, although specific management of LVAD patients on dialysis is complex and beyond the scope of this review.…”

Section: Lvadsmentioning

confidence: 99%

Heart failure management in dialysis patients: Many treatment options with no clear evidence

Roehm

Gulati

Weiner

2020

Seminars in Dialysis

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Heart failure with reduced ejection fraction (HFrEF) impacts approximately 20% of dialysis patients and is associated with high mortality rates. Key issues discussed in this review of HFrEF management in dialysis include dialysis modality choice, vascular access, dialysate composition, pharmacological therapies, and strategies to reduce sudden cardiac death, including the use of cardiac devices. Peritoneal dialysis and more frequent or longer duration of hemodialysis may be better tolerated due to slower ultrafiltration rates, leading to less intradialytic hypotension and better volume control; dialysate cooling and higher dialysate calcium may also have benefits. While high‐quality evidence exists for many drug classes in the non‐dialysis population, dialysis patients were excluded from major trials, and only limited data exist for many medications in kidney failure patients. Despite limited evidence, beta blocker and angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker use is common in dialysis. Similarly, devices such as implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy that have proven benefits in non‐dialysis HFrEF patients have not consistently been beneficial in the limited dialysis studies. The use of leadless pacemakers and subcutaneous ICDs can mitigate future hemodialysis access limitations. Additional research is critical to address knowledge gaps in treating maintenance dialysis patients with HFrEF.

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Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices

Cited by 38 publications

References 29 publications

Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Heart failure management in dialysis patients: Many treatment options with no clear evidence

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