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.
| Language | English (US) |
|---|---|
| Journal | Journal of Heart and Lung Transplantation |
| DOIs | |
| State | Accepted/In press - Jan 1 2017 |
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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; 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: Contribution to journal › Article
}
TY - JOUR
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
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
UR - http://www.scopus.com/inward/record.url?scp=85034787447&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034787447&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2017.11.005
DO - 10.1016/j.healun.2017.11.005
M3 - Article
JO - Journal of Heart and Lung Transplantation
T2 - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
ER -