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Kidney Week

Abstract: TH-OR115

Outcomes after Left Ventricular Assist Device Implantation in Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • Long, Jin, Stanford University, Palo Alto, California, United States
  • Zheng, Yuanchao, Stanford University, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
Background

Left ventricular assist devices (LVAD) are increasingly used as a bridge to heart transplant and destination therapy for heart failure. Although acute kidney injury (AKI) is a common complication in these patients, there are few multicenter studies on how AKI affects LVAD outcomes. We sought to determine outcomes associated with AKI among patients receiving LVADs in a nationally representative sample of hospitalizations in the US.

Methods

Using the National Inpatient Sample from 2008 to 2013, we identified patients who received a LVAD during a hospitalization using ICD-9 code 37.66. We ascertained AKI and acute dialysis using validated ICD-9 codes. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications and discharge destination. We used logistic regression to adjust for demographics, hospital-level factors, comorbidities, and acute hospitalization details.

Results

We identified 8362 patients who received a LVAD, of whom 3760 (45%) developed AKI without dialysis (AKI-ND) and 426 (5%) developed AKI-requiring dialysis (AKI-D). In-hospital mortality increased from 4% for patients without AKI, to 12% for patients with AKI-ND, to 48% for patients with AKI-D. We observed similar increases for major bleeding (25% vs 33% vs 49%) and sepsis (9% vs 22% vs 43%). Discharge destination was home for 84% of patients without AKI, 72% of patients with AKI-ND, and 56% of patients with AKI-D. After multivariable adjustment, patients with AKI-ND and AKI-D had higher odds of mortality (OR 3.24, 95% CI 2.04-5.13 and 20.8, 95% CI 9.7-44.2), major bleeding (1.38, 95% CI 1.08-1.77 and 2.43, 95% CI 1.47-4.04), sepsis (2.69, 95% CI 1.93-3.75 and 5.75, 95% CI 3.46-9.56), and discharge to a nursing facility (2.15, 95% CI 1.51-3.07 and 5.89, 95% CI 2.67-12.99). Patients with AKI-ND and AKI-D on mechanical ventilation had a markedly increased adjusted odds of death (14.2, 95% CI 7.5-26.9 and 90.9, 95% CI 41.4-199.6). None of the patients with AKI-D received a heart transplant during the same hospitalization as LVAD implantation.

Conclusion

During a hospitalization in which a LVAD is implanted, patients with AKI are at increased risk of procedural complications and death. The prognosis is particularly poor for patients with AKI-D. This information is necessary to support shared decision-making for patients with advanced heart failure and AKI.