Abstract: FR-PO039
CKD and AKI Outcomes After Left Ventricular Assist Device Implantation
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ajmal, Muhammad Suleman, Baylor College of Medicine, Sugar Land, Texas, United States
- Parikh, Umang, Baylor College of Medicine, Sugar Land, Texas, United States
- Lamba, Harveen, Baylor College of Medicine, Sugar Land, Texas, United States
- Walther, Carl P., Baylor College of Medicine, Sugar Land, Texas, United States
Background
Left ventricular assist devices (LVAD) are used as a bridge to heart transplant or destination therapy for patients with end-stage heart failure. Acute kidney injury (AKI) or need for renal replacement therapy (RRT) post LVAD implant can lead to poor outcomes. Identifying risk factors of AKI post LVAD can help stratify LVAD candidates.
Methods
A retrospective study of all patients who received continuous-flow LVAD at our institution from January 2015 until August 2017. We calculated incidence of AKI and need for RRT post LVAD implant, rate of renal recovery and survival rates at 30 days and 1-year post implant. Presence of Chronic kidney disease (CKD) with staging and proteinuria was assessed and a prior kidney ultrasound (KU) was reviewed for all patients if available. CKD was present if eGFR<60 ml/min per 1.73m2 for >3 months preceding LVAD implant and/or proteinuria> 20mg/dl on 2 or more urine analysis prior to implant and/or an abnormal KU with increased echogenicity or small size <9 cm. AKI was defined per KDIGO guidelines
Results
A total of 137 patients received LVAD. 112 males and 25 females with mean age of 59.2 years. Race: 64 Caucasians, 38 Africans, 30 Hispanics and 5 Asians. Incidence of AKI and need for RRT during hospitalization post LVAD implant were calculated in all patients and in sub-groups based on the presence of CKD, underlying CKD stage, proteinuria and KU findings. See table.
30 day and 1-year mortality rates post LVAD implant were 4.3% and 21.1% respectively. Out of the 27 patients requiring RRT, 9 (33%) were off RRT at 1 year. Compared to eGFR on day of LVAD implant, eGFR at 30 days post LVAD showed 57% patients with higher and 42% with lower eGFR. At 1 year, eGFR was higher in 32% and lower in 67% patients.
Conclusion
Incidence of AKI and need for RRT post LVAD implant are very high. Of all patients, 2 out of 3 patients had a lower eGFR at 1-year post implant and only 1 out of 3 patients requiring RRT recovered at 1-year post implant. Presence of CKD, advanced CKD stage and abnormal KU are statistically significant (P <0.05) risk factors of AKI post LVAD and/or need for RRT.
Incidence of AKI and need for RRT
| All Patients | No CKD | CKD Present | CKD stage 1-2 | CKD stage 3-5 | No Proteinuria | Proteinuria Present | Normal Kidney Ultrasound | Abnormal Kidney Ultrasound | |
| Incidence of AKI | 88/137=64% | 18/42=43% | 64/84=76% | 15/25=60% | 41/47=87% | 49/85=58% | 33/45=73% | 63/103=61% | 17/24=71% |
| P value=0.028 | P value=0.0081 | P value=0.0778 | P value=0.376 | ||||||
| Need for RRT | 27/137=19.7% | 4/42=9% | 23/84=27% | 6/25=24% | 11/47=23% | 15/85=18% | 10/45=22% | 16/103=15% | 8/24=33% |
| P value=0.0153 | P value=0.775 | P value=0.5288 | P value=0.0448 | ||||||