Acute kidney injury and 1-year mortality after left ventricular assist device implantation

Rahatullah Muslem, Kadir Caliskan, Sakir Akin, Kavita Sharma, Nisha A. Gilotra, Alina A. Constantinescu, Brian Houston, Glenn Whitman, Ryan J. Tedford, Dennis A. Hesselink, Ad J.J.C. Bogers, Stuart D. Russell, Olivier C. Manintveld

Research output: Research - peer-reviewArticle

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.

LanguageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Heart-Assist Devices
Acute Kidney Injury
Mortality
Heart Ventricles
Kidney
Confidence Intervals
Equipment and Supplies
Kidney Diseases
Glomerular Filtration Rate
Chronic Renal Insufficiency
Multicenter Studies
Cohort Studies
Incidence

Keywords

  • Heart failure
  • KDIGO
  • Left ventricular assist device
  • Mechanical circulatory support
  • Renal insufficiency
  • Renal replacement therapy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Acute kidney injury and 1-year mortality after left ventricular assist device implantation. / Muslem, Rahatullah; Caliskan, Kadir; Akin, Sakir; Sharma, Kavita; Gilotra, Nisha A.; Constantinescu, Alina A.; Houston, Brian; Whitman, Glenn; Tedford, Ryan J.; Hesselink, Dennis A.; Bogers, Ad J.J.C.; Russell, Stuart D.; Manintveld, Olivier C.

In: Journal of Heart and Lung Transplantation, 01.01.2017.

Research output: Research - peer-reviewArticle

Muslem, Rahatullah ; Caliskan, Kadir ; Akin, Sakir ; Sharma, Kavita ; Gilotra, Nisha A. ; Constantinescu, Alina A. ; Houston, Brian ; Whitman, Glenn ; Tedford, Ryan J. ; Hesselink, Dennis A. ; Bogers, Ad J.J.C. ; Russell, Stuart D. ; Manintveld, Olivier C./ Acute kidney injury and 1-year mortality after left ventricular assist device implantation. In: Journal of Heart and Lung Transplantation. 2017
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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.",
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author = "Rahatullah Muslem and Kadir Caliskan and Sakir Akin and Kavita Sharma and Gilotra, {Nisha A.} and Constantinescu, {Alina A.} and Brian Houston and Glenn Whitman and Tedford, {Ryan J.} and Hesselink, {Dennis A.} and Bogers, {Ad J.J.C.} and Russell, {Stuart D.} and Manintveld, {Olivier C.}",
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T1 - Acute kidney injury and 1-year mortality after left ventricular assist device implantation

AU - Muslem,Rahatullah

AU - Caliskan,Kadir

AU - Akin,Sakir

AU - Sharma,Kavita

AU - Gilotra,Nisha A.

AU - Constantinescu,Alina A.

AU - Houston,Brian

AU - Whitman,Glenn

AU - Tedford,Ryan J.

AU - Hesselink,Dennis A.

AU - Bogers,Ad J.J.C.

AU - Russell,Stuart D.

AU - Manintveld,Olivier C.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Heart failure

KW - KDIGO

KW - Left ventricular assist device

KW - Mechanical circulatory support

KW - Renal insufficiency

KW - Renal replacement therapy

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