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Kidney Function Following Left Ventricular Assist Device Implantation: An Observational Cohort Study
Nicholas Wettersten1,2, Michelle Estrella3, Michela Brambatti2
1Cardiology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA.
Insights
Left ventricular assist device (LVAD) implantation can improve kidney function in heart failure patients. Younger age, lower kidney function, and absence of diabetes mellitus predict 1-month eGFR improvement post-LVAD.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Nearly half of heart failure patients have co-existing chronic kidney disease (CKD).
- Left ventricular assist device (LVAD) implantation can improve kidney function, but not in all patients.
- Lack of kidney function improvement after LVAD is linked to poorer outcomes.
Purpose of the Study:
- To identify preimplantation factors that predict changes in kidney function after LVAD implantation.
- To understand which patient characteristics are associated with improved estimated glomerular filtration rate (eGFR) post-LVAD.
Main Methods:
- Single-center observational study of consecutive patients undergoing LVAD implantation.
- Analysis of 48 preimplantation variables including demographic, clinical, laboratory, hemodynamic, and echocardiographic data.
- Univariable and multivariable linear regression models were used to assess predictors of eGFR change.
Main Results:
- Among 131 patients, 75% showed improved eGFR at 1 month post-LVAD.
- Younger age, absence of diabetes mellitus (DM), lower baseline eGFR, and higher levels of certain liver and kidney biomarkers predicted 1-month eGFR improvement.
- In multivariable analysis, younger age, lower eGFR, and absence of DM were independently associated with 1-month eGFR increase.
Conclusions:
- Preimplantation factors like younger age, lower eGFR, and absence of DM are associated with improved kidney function at 1 month after LVAD.
- Predicting significant eGFR changes beyond 1 month using preimplantation variables is limited.
- Further research is needed to fully understand long-term kidney function changes post-LVAD.
Rationale & Objective:
Nearly half the patients with heart failure have chronic kidney disease. Implantation of a left ventricular assist device (LVAD) improves kidney function in some but not all patients, and lack of improvement is associated with worse outcomes. Preimplantation factors that predict change in kidney function after LVAD placement are not well described.
Study Design:
Single-center observational study.
Setting & Participants:
Consecutive patients undergoing LVAD implantation.
Predictors:
48 diverse preimplantation variables including demographic, clinical, laboratory, hemodynamic, and echocardiographic variables.
Outcomes:
The primary outcome was change in estimated glomerular filtration rate (eGFR) at 1 month after implantation. Secondary outcomes included eGFR changes at 3, 6, and 12 months.
Analytic Approach:
Univariable and multivariable linear regression.
Results:
Among 131 patients, average age was 60 ± 13 years, 83% were men, 47% had pre-existing chronic kidney disease, and mean preimplantation eGFR was 57 ± 23 mL/min/1.73 m2. At 1-month following LVAD implantation, eGFR improved in 98 (75%) patients. Variables associated with 1-month increases in eGFR were younger age, absence of diabetes mellitus (DM), use of inotropes, lower implantation eGFR, and higher implantation serum urea nitrogen, alanine aminotransferase, bilirubin, and creatinine levels. In multivariable models, younger age (β = 7.14 mL/min/1.73 m2 per SD; 95% CI, 3.17-11.10), lower eGFR (β = 7.72 mL/min/1.73 m2 per SD; 95% CI, 3.10-12.34), and absence of DM (β = 10.36 mL/min/1.73 m2; 95% CI, 2.99-17.74) were each independently associated with 1-month improvement in eGFR. Only younger age and lower eGFR were associated with improvements in eGFR at later months.
Limitations:
Single-center study. Loss to follow-up from heart transplantation and death over duration of study.
Conclusions:
Only younger age, lower eGFR, and absence of DM were associated with improvement in eGFR at 1 month. Thus, prediction of eGFR change at 1 month and beyond is limited by using preimplantation variables.
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