Kidney Week

Abstract: TH-OR101

Changes in eGFR After Left Ventricular Assist Device Implantation

Session Information

• Hypertension and CVD: Therapies and Predictors
  November 07, 2019 | Location: 206, Walter E. Washington Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Roehm, Bethany, Tufts Medical Center, Boston, Massachusetts, United States

Bethany Roehm, MD, MS

• Inker, Lesley, Tufts Medical Center, Boston, Massachusetts, United States

Lesley Inker,

• Vest, Amanda, Tufts Medical Center, Boston, Massachusetts, United States

Amanda Vest,

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States

Daniel E. Weiner,

Background

Patients with advanced heart failure have a one-year survival of 25% which increases to more than 80% with left ventricular assist device (LVAD) support. Lower glomerular filtration rate (GFR), generally <30 ml/min/1.73m², is a relative contraindication to LVAD implantation. However reduced GFR may be secondary to decreased kidney perfusion that may improve after LVAD implantation. Our goal was to investigate kidney function following LVAD implantation.

Methods

We evaluated the change in eGFR among all patients at Tufts Medical Center who received an LVAD between 2010 and 2018 from baseline to 6 months, 1 year, and 2 years after implantation. Primary outcome was increase or decrease in eGFR by 30% or more, death on LVAD support, or heart transplantation, which were examined overall and by baseline eGFR category (>60, 30-59 and <30 ml/min/1.73m²).

Results

Among 288 patients, mean baseline eGFR was 62 ±23 ml/min/1.73m². There were 144 patients with baseline eGFR ≥60, 122 with eGFR 30-59, and 22 with eGFR <30 ml/min/1.73m². Most LVAD recipients had an increase in eGFR or remained stable (Figure), and none with an eGFR <30 had a decline in eGFR. Death was also common, particularly in those with an eGFR<60. Among those with eGFR ≥60, 23% died within two years compared to 40% for those with eGFR <60 (p=0.004).

Conclusion

Substantial decreases in eGFR are rare in patients following LVAD implantation, even among patients with lowest baseline eGFR. One-year survival for patients with lower baseline eGFR is low, but remains better than reported one-year survival among LVAD eligible patients who do not receive LVAD support. Carefully selected patients with lower eGFR should not necessarily be excluded from receiving LVADs for treatment of heart failure.

Figure: Outcomes over time post LVAD. Increase and decrease are defined as 30% increase or decrease in eGFR at follow-up.

Funding

• Other NIH Support