Kidney Outcomes in Patients With Advanced Heart Failure Treated With Ventricular Assist Devices.

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Advanced heart failure often necessitates ventricular assist devices (VADs).
• The impact of VADs on kidney function, including acute kidney injury (AKI) and kidney replacement therapy (KRT) needs, remains incompletely understood.

Purpose of the Study:

• To evaluate changes in kidney function following VAD implantation.
• To assess the incidence of AKI and the need for KRT in patients receiving VADs.
• To explore the influence of pre-existing chronic kidney disease (CKD) on post-VAD kidney outcomes.

Main Methods:

• Retrospective cohort study of adult patients undergoing durable VAD placement (2009-2019).
• Patients stratified into CKD (eGFR <60 mL/min/1.73m²) and non-CKD (eGFR ≥60 mL/min/1.73m²) groups.
• Analysis of longitudinal kidney function (eGFR, creatinine), AKI incidence, and KRT requirements at 3 and 12 months post-VAD.

Main Results:

• VAD placement initially improved kidney function in CKD patients (eGFR +17 at 3 months), but this benefit diminished by 12 months (eGFR +7).
• Non-CKD patients showed a smaller, unsustained improvement in kidney function.
• AKI requiring KRT occurred in 14% of patients, with significant in-hospital mortality (45%); 21% experienced post-discharge AKI.

Conclusions:

• VAD implantation offers an initial improvement in kidney function, particularly for patients with CKD, though this effect is not sustained long-term.
• The high incidence of AKI and KRT requirement underscores the critical need for vigilant kidney function monitoring in patients with VADs.
• Heart transplantation post-VAD was associated with worsening kidney function at one year.