Prevalence and prognostic importance of changes in renal function after mechanical circulatory support

Meredith A. Brisco, Stephen E. Kimmel, Steven G. Coca, Mary E. Putt, Mariell Jessup, Wilson W.H. Tang, Chirag R. Parikh, Jeffrey M. Testani

Research output: Contribution to journalArticle

Abstract

Background.The long-term durability and prognostic significance of improvement in renal function after mechanical circulatory support (MCS) has yet to be characterized in a large multicenter population. The primary goals of this analysis were to describe serial post-MCS changes in estimated glomerular filtration rate (eGFR) and determine their association with all-cause mortality. Methods and Results.Adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with serial creatinine levels available (n=3363) were studied. Early post-MCS, eGFR improved substantially (median improvement, 48.9%; P<0.001) with 22.3% of the population improving their eGFR by .100% within the first few weeks. However, in the majority of patients, this improvement was transient, and by 1 year, eGFR was only 6.7% above the pre-MCS value (P<0.001). This pattern of early improvement followed by deterioration in eGFR was observed with both pulsatile and continuous-flow devices. Interestingly, poor survival was associated with both marked improvement (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.19.2.26; P=0.002) and worsening in eGFR (adjusted HR, 1.63; 95% CI, 1.15.2.13; P=0.004). Conclusions.Post-MCS, early improvement in renal function is common but seems to be largely transient and not necessarily indicative of an improved prognosis. This pattern was observed with both pulsatile and continuous-flow devices. Additional research is necessary to better understand the mechanistic basis for these complex post-MCS changes in renal function and their associated survival disadvantage.

Original languageEnglish (US)
Pages (from-to)68-75
Number of pages8
JournalCirculation: Heart Failure
Volume7
Issue number1
DOIs
StatePublished - Jan 2014

Keywords

  • Cardio-renal syndrome
  • Heart failure
  • Heart-assist devices
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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