Concurrent Use of Kidney Replacement Therapy and Temporary Left Ventricular Assist Device in Cardiogenic Shock: A...

Introduction: The use of temporary-left ventricular assist devices (T-LVADs) for circulatory support in cardiogenic shock is increasing along with complications like acute kidney injury requiring kidney replacement therapy (KRT). While KRT is linked to mortality in cardiogenic shock, data on mortality in patients receiving both T-LVAD and KRT are limited.

We conducted a systematic review and meta-analysis, searching three databases from inception through December 30, 2023, for studies reporting on patients with concurrent T-LVAD and KRT support during cardiogenic shock. We performed random-effects meta-analyses, looking at in-hospital mortality as our primary outcome. Subgroup analysis was performed based on the continent, timing of KRT, and type of T-LVAD. Risk of bias was assessed with the Joanna Briggs Institute checklists and certainty of evidence with the GRADE approach.

We included 35 studies after screening through 89 full-text articles, consisting of 2,277 individuals receiving T-LVAD and 722 (30.9%, 95% CI: 25.8-36.6) receiving concurrent KRT. In-hospital mortality was pooled across 6 studies, with 91 non-survivors (65.5%) among 139 individuals (95% CI: 57.2-72.9). Concurrent KRT and T-LVAD was associated with higher in-hospital (OR 3.48, 95% CI: 2.20-5.49) and overall mortality (OR 2.19, 95% CI: 1.01-4.76) compared to patients not on KRT. The proportion of patients on KRT was significantly (p interaction = 0.0004) larger in Europe (37.2%, 95% CI: 32.2-42.4) than North America (18.2%, 95% CI: 12.0-26.7). Region, type of T-LVAD, and publication year did not significantly impact any of the mortality outcomes.

Patients on concurrent KRT and T-LVAD suffer significantly greater odds of mortality compared to patients not receiving KRT during their hospital admission. A substantial proportion of patients receiving T-LVADs require KRT. Further studies with head-to-head comparisons between KRT and non-KRT treatment arms are warranted to confirm our findings, in addition to identifying at-risk populations that require KRT and potential interventions to improve survival in this subset of patients.