New Dialysis-Dependent Renal Failure After Durable LVAD Implantation: Risk Factors and Potential Targets for...

To identify preoperative predictors of postoperative renal replacement therapy (RRT) in patients undergoing left ventricular assist device (LVAD) implantation to help guide interventions that could decrease the incidence of new dialysis-dependent acute kidney injury (AKI).

Retrospective cohort study.

A single-center, university hospital.

There were 159 adult patients undergoing LVAD implantation between July 2012 to July 2024 INTERVENTIONS: Retrospective analysis of preoperative variables, including hemoglobin, creatinine, MELD score, and intraoperative RBC transfusion volume and their effect on the primary outcome of new dialysis-dependent AKI.

New dialysis-dependent AKI occurred in 17% of patients. Preoperative hemoglobin was inversely associated with RRT risk; every 1-g/dL increase was associated with a 21% reduction in odds ratio (OR 0.79; CI 0.65-0.97, p = .023). Intraoperative red blood cell transfusion volume was a major predictor, with patients receiving 0 to 5 units having significantly lower OR than those receiving ≥11 units (OR 0.01; 95% CI 0.001-0.11; p < .001). MELD scores between 10 and 20 also increased the OR (OR 3.10; 95% CI 1.07-9.00; p = .038). Additionally, needing new dialysis was strongly associated with prolonged mechanical ventilation (OR 8.76; 95% CI 2.52-30.5; p = .001) and postoperative gastrointestinal bleeding (OR 3.73; 95% CI 1.48-9.40; p = .005).

Preoperative hemoglobin and perioperative red blood cell transfusion volume are significant and potentially actionable, modifiable risk factors for postoperative RRT in LVAD recipients. Optimizing preoperative hemoglobin may offer a targeted strategy to reduce RRT rates in this high-risk population.