Long-Term Changes in Estimated Glomerular Filtration Rate in Left Ventricular Assist Device Recipients: A...

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Advanced kidney disease is a concern for left ventricular assist device (LVAD) implantation due to potential poor outcomes.
• Limited data exist on long-term estimated glomerular filtration rate (eGFR) changes and sex-based differences post-LVAD, with bias from competing risks.
• Understanding eGFR trajectories is crucial for managing patients with heart failure and kidney disease undergoing LVAD therapy.

Purpose of the Study:

• To evaluate long-term changes in eGFR in adult patients following LVAD implantation.
• To investigate potential sex-based differences in eGFR trajectories after LVAD implantation.
• To adjust for competing risks of death and heart transplantation in the analysis of eGFR changes.

Main Methods:

• Longitudinal analysis of 288 adult patients receiving continuous-flow LVADs between 2010 and 2017.
• A joint model was used to assess eGFR changes over 2 years, accounting for death and heart transplantation.
• Baseline eGFR and changes at 6 months, 1 year, and 2 years were analyzed, with stratification by sex.

Main Results:

• Median baseline eGFR was 60 mL/min/1.73 m²; 74 patients died and 104 received transplants within 2 years.
• An initial modest increase in eGFR (≈2 mL/min/1.73 m²) was observed within 6 months, followed by a decline below baseline at 1 and 2 years.
• Men showed an eGFR decline of 5-10 mL/min/1.73 m² in the first year, stabilizing thereafter. Women had an initial ≈5 mL/min/1.73 m² increase within 6 months, then declined towards baseline (interaction P=0.005).

Conclusions:

• Estimated GFR generally remains stable in the majority of patients after LVAD implantation.
• Significant sex-based differences in eGFR trajectory were observed, warranting further investigation.
• Larger studies are needed to explore eGFR changes and mortality in LVAD recipients with lower baseline eGFR.