Kidney Week

Abstract: TH-OR115

Outcomes after Left Ventricular Assist Device Implantation in Patients with AKI

Session Information

• Predicting AKI and Clinical Outcomes
  October 25, 2018 | Location: 1B, San Diego Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Silver, Samuel A., Queen's University, Kingston, Ontario, Canada

Samuel A. Silver, MD, MS, FASN



Samuel Silver is an Assistant Professor in the Division of Nephrology at Queen’s University in Kingston, Ontario, Canada. The objective of his research program is to use administrative data and systematic reviews to inform the design of quality improvement interventions that may improve patient outcomes. Samuel’s research interests focus on the delivery of care for patients with acute kidney injury, both during the inpatient and outpatient setting. Samuel currently lives in Kingston, Ontario, with his wife and three young children.

• Long, Jin, Stanford University, Palo Alto, California, United States

Jin Long,

• Zheng, Yuanchao, Stanford University, Palo Alto, California, United States

Yuanchao Zheng,

• Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Glenn Matthew Chertow,

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.