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Effect of Age and Renal Function on Survival After Left Ventricular Assist Device Implantation
Rahatullah Muslem1, Kadir Caliskan1, Sakir Akin2
1Thoraxcenter, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Age significantly impacts renal function and survival after left ventricular assist device (LVAD) implantation. Older patients (>60 years) with impaired kidney function face a substantially higher mortality risk within the first year.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Left ventricular assist devices (LVADs) are increasingly utilized, particularly for destination therapy in elderly populations.
- Assessing the impact of patient age on outcomes following LVAD implantation is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the effect of age on renal function (eGFR) one year post-LVAD implantation.
- To determine the association between age, renal function, and 1-year mortality in LVAD recipients.
Main Methods:
- Retrospective multicenter cohort study of 241 LVAD patients (age ≥18).
- Patients stratified into age groups: <45, 45-54, 55-64, and ≥65 years.
- Analysis of estimated Glomerular Filtration Rate (eGFR) and survival rates at 1 year.
Main Results:
- Mean 1-year eGFR significantly decreased with increasing age groups (85 to 49 mL/min/1.73 m²).
- Older age and lower baseline eGFR independently predicted worse renal function at 1 year.
- 1-year survival rates declined with age (79% for <45 years to 54% for ≥65 years).
- Older age (>60 years) and impaired renal function (eGFR <55) conferred a 5-fold increased mortality hazard.
Conclusions:
- Age >60 years is an independent predictor of impaired renal function and mortality post-LVAD.
- Pre-existing reduced renal function exacerbates the negative impact of older age on LVAD patient survival.
Abstract:
Left ventricular assist devices (LVAD) are increasingly used, especially as destination therapy in in older patients. The aim of this study was to evaluate the effect of age on renal function and mortality in the first year after implantation. A retrospective multicenter cohort study was conducted, evaluating all LVAD patients implanted in the 2 participating centers (age ≥18 years). Patients were stratified according to the age groups <45, 45-54, 55-64, and ≥65 years old. Overall, 241 patients were included (mean age 52.4 ± 12.9 years, 76% males, 33% destination therapy). The mean estimated Glomerular Filtration Rate (eGFR) at 1 year was 85, 72, 69, and 49 mL/min per 1.73 m2 in the age groups <45(n = 65, 27%), 45-54(n = 52, 22%), 55-64(n = 87, 36%), and ≥65 years (n = 37, 15%) p <0.001)), respectively. Older age and lower eGFR at baseline (p <0.01) were independent predictors of worse renal function at 1 year. The 1-year survival post-implantation was 79%,84%, 68%, and 54% for those in the age group <45, 45-54, 55-64 and ≥65 years (Log-rank p = 0.003). Older age, lower eGFR and, INTERMACS class I were independent predictors of 1-year mortality. Furthermore, older patients (age > 60 years) with an impaired renal function (eGFR <55 mL/min per 1.73 m2) had a 5-fold increased hazard ratio for mortality during the first year after implantation (p <0.001). In conclusion, age >60 years is an independent predictor for an impaired renal function and mortality. Older age combined with reduced renal function pre-implantation had a cumulative adverse effect on survival in patients receiving a LVAD.