Pre-operative proteinuria in left ventricular assist devices and clinical outcome

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

Research output: Contribution to journalArticle

Abstract

Background: This study evaluated the association of pre-operative proteinuria before continuous flow left ventricular assist device (CF-LVAD) implantation in relation to mortality and the need for renal replacement therapy (RRT) during the first year of follow-up. Methods: This retrospective, multicenter cohort study evaluated all patients (n = 241) who underwent CF-LVAD implantation in the 2 participating tertiary referral centers. Patients were included if a urine dipstick was performed within 7 days before CF-LVAD implantation. Proteinuria was defined as trace or higher. Results: In total, 173 patients (72%) were included (78% men; mean age, 52.3 ± 13.3; mean estimated glomerular filtration rate, 60.1 ± 25.9 mL/min/1.73 m2), and 42 patients (24%) had pre-operative proteinuria. The observed survival in patients with proteinuria vs without proteinuria was 57% vs 86% at 3 months and 52% vs 78% at 1 year (log-rank p < 0.001), respectively. In addition, during the first year after implantation, 32% of the patients with proteinuria and 15% of the patients without proteinuria required RRT (log-rank p = 0.02). Multivariate Cox regression analysis confirmed that pre-operative proteinuria was an independent predictor for mortality (adjusted hazard ratio, 2.09; 95% confidence interval, 1.10-3.80, p = 0.02) and for the need of RRT during the first year (adjusted hazard ratio, 2.23; 95% confidence interval, 1.13-4.84; p = 0.02). Conclusions: Proteinuria, which was present in 25% of all tested LVAD patients, predicts worse outcome in all-cause mortality and need of RRT in patients with a CF-LVAD. This warrants the use of proteinuria in risk stratification when selecting patients for CF-LVAD therapy.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart-Assist Devices
Proteinuria
Renal Replacement Therapy
Mortality
Confidence Intervals
Glomerular Filtration Rate
Tertiary Care Centers
Multicenter Studies
Cohort Studies
Regression Analysis
Urine

Keywords

  • Left ventricular assist device
  • Mechanical circulatory support
  • Proteinuria
  • Renal function
  • Renal replacement therapy

ASJC Scopus subject areas

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

Cite this

Pre-operative proteinuria in left ventricular assist devices and clinical outcome. / Muslem, Rahatullah; Caliskan, Kadir; Akin, Sakir; Sharma, Kavita; Gilotra, Nisha; Brugts, Jasper J.; Houston, Brian; Whitman, Glenn; Tedford, Ryan J.; Hesselink, Dennis A.; Bogers, Ad J.J.C.; Manintveld, Olivier C.; Russell, Stuart D.

In: Journal of Heart and Lung Transplantation, 2017.

Research output: Contribution to journalArticle

Muslem, R, Caliskan, K, Akin, S, Sharma, K, Gilotra, N, Brugts, JJ, Houston, B, Whitman, G, Tedford, RJ, Hesselink, DA, Bogers, AJJC, Manintveld, OC & Russell, SD 2017, 'Pre-operative proteinuria in left ventricular assist devices and clinical outcome', Journal of Heart and Lung Transplantation. https://doi.org/10.1016/j.healun.2017.07.011
Muslem, Rahatullah ; Caliskan, Kadir ; Akin, Sakir ; Sharma, Kavita ; Gilotra, Nisha ; Brugts, Jasper J. ; Houston, Brian ; Whitman, Glenn ; Tedford, Ryan J. ; Hesselink, Dennis A. ; Bogers, Ad J.J.C. ; Manintveld, Olivier C. ; Russell, Stuart D. / Pre-operative proteinuria in left ventricular assist devices and clinical outcome. In: Journal of Heart and Lung Transplantation. 2017.
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abstract = "Background: This study evaluated the association of pre-operative proteinuria before continuous flow left ventricular assist device (CF-LVAD) implantation in relation to mortality and the need for renal replacement therapy (RRT) during the first year of follow-up. Methods: This retrospective, multicenter cohort study evaluated all patients (n = 241) who underwent CF-LVAD implantation in the 2 participating tertiary referral centers. Patients were included if a urine dipstick was performed within 7 days before CF-LVAD implantation. Proteinuria was defined as trace or higher. Results: In total, 173 patients (72{\%}) were included (78{\%} men; mean age, 52.3 ± 13.3; mean estimated glomerular filtration rate, 60.1 ± 25.9 mL/min/1.73 m2), and 42 patients (24{\%}) had pre-operative proteinuria. The observed survival in patients with proteinuria vs without proteinuria was 57{\%} vs 86{\%} at 3 months and 52{\%} vs 78{\%} at 1 year (log-rank p < 0.001), respectively. In addition, during the first year after implantation, 32{\%} of the patients with proteinuria and 15{\%} of the patients without proteinuria required RRT (log-rank p = 0.02). Multivariate Cox regression analysis confirmed that pre-operative proteinuria was an independent predictor for mortality (adjusted hazard ratio, 2.09; 95{\%} confidence interval, 1.10-3.80, p = 0.02) and for the need of RRT during the first year (adjusted hazard ratio, 2.23; 95{\%} confidence interval, 1.13-4.84; p = 0.02). Conclusions: Proteinuria, which was present in 25{\%} of all tested LVAD patients, predicts worse outcome in all-cause mortality and need of RRT in patients with a CF-LVAD. This warrants the use of proteinuria in risk stratification when selecting patients for CF-LVAD therapy.",
keywords = "Left ventricular assist device, Mechanical circulatory support, Proteinuria, Renal function, Renal replacement therapy",
author = "Rahatullah Muslem and Kadir Caliskan and Sakir Akin and Kavita Sharma and Nisha Gilotra and Brugts, {Jasper J.} and Brian Houston and Glenn Whitman and Tedford, {Ryan J.} and Hesselink, {Dennis A.} and Bogers, {Ad J.J.C.} and Manintveld, {Olivier C.} and Russell, {Stuart D.}",
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T1 - Pre-operative proteinuria in left ventricular assist devices and clinical outcome

AU - Muslem, Rahatullah

AU - Caliskan, Kadir

AU - Akin, Sakir

AU - Sharma, Kavita

AU - Gilotra, Nisha

AU - Brugts, Jasper J.

AU - Houston, Brian

AU - Whitman, Glenn

AU - Tedford, Ryan J.

AU - Hesselink, Dennis A.

AU - Bogers, Ad J.J.C.

AU - Manintveld, Olivier C.

AU - Russell, Stuart D.

PY - 2017

Y1 - 2017

N2 - Background: This study evaluated the association of pre-operative proteinuria before continuous flow left ventricular assist device (CF-LVAD) implantation in relation to mortality and the need for renal replacement therapy (RRT) during the first year of follow-up. Methods: This retrospective, multicenter cohort study evaluated all patients (n = 241) who underwent CF-LVAD implantation in the 2 participating tertiary referral centers. Patients were included if a urine dipstick was performed within 7 days before CF-LVAD implantation. Proteinuria was defined as trace or higher. Results: In total, 173 patients (72%) were included (78% men; mean age, 52.3 ± 13.3; mean estimated glomerular filtration rate, 60.1 ± 25.9 mL/min/1.73 m2), and 42 patients (24%) had pre-operative proteinuria. The observed survival in patients with proteinuria vs without proteinuria was 57% vs 86% at 3 months and 52% vs 78% at 1 year (log-rank p < 0.001), respectively. In addition, during the first year after implantation, 32% of the patients with proteinuria and 15% of the patients without proteinuria required RRT (log-rank p = 0.02). Multivariate Cox regression analysis confirmed that pre-operative proteinuria was an independent predictor for mortality (adjusted hazard ratio, 2.09; 95% confidence interval, 1.10-3.80, p = 0.02) and for the need of RRT during the first year (adjusted hazard ratio, 2.23; 95% confidence interval, 1.13-4.84; p = 0.02). Conclusions: Proteinuria, which was present in 25% of all tested LVAD patients, predicts worse outcome in all-cause mortality and need of RRT in patients with a CF-LVAD. This warrants the use of proteinuria in risk stratification when selecting patients for CF-LVAD therapy.

AB - Background: This study evaluated the association of pre-operative proteinuria before continuous flow left ventricular assist device (CF-LVAD) implantation in relation to mortality and the need for renal replacement therapy (RRT) during the first year of follow-up. Methods: This retrospective, multicenter cohort study evaluated all patients (n = 241) who underwent CF-LVAD implantation in the 2 participating tertiary referral centers. Patients were included if a urine dipstick was performed within 7 days before CF-LVAD implantation. Proteinuria was defined as trace or higher. Results: In total, 173 patients (72%) were included (78% men; mean age, 52.3 ± 13.3; mean estimated glomerular filtration rate, 60.1 ± 25.9 mL/min/1.73 m2), and 42 patients (24%) had pre-operative proteinuria. The observed survival in patients with proteinuria vs without proteinuria was 57% vs 86% at 3 months and 52% vs 78% at 1 year (log-rank p < 0.001), respectively. In addition, during the first year after implantation, 32% of the patients with proteinuria and 15% of the patients without proteinuria required RRT (log-rank p = 0.02). Multivariate Cox regression analysis confirmed that pre-operative proteinuria was an independent predictor for mortality (adjusted hazard ratio, 2.09; 95% confidence interval, 1.10-3.80, p = 0.02) and for the need of RRT during the first year (adjusted hazard ratio, 2.23; 95% confidence interval, 1.13-4.84; p = 0.02). Conclusions: Proteinuria, which was present in 25% of all tested LVAD patients, predicts worse outcome in all-cause mortality and need of RRT in patients with a CF-LVAD. This warrants the use of proteinuria in risk stratification when selecting patients for CF-LVAD therapy.

KW - Left ventricular assist device

KW - Mechanical circulatory support

KW - Proteinuria

KW - Renal function

KW - Renal replacement therapy

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