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Abstract: PO0013

Incidence and Impact of AKI on Patients with Implantable Left Ventricular Assist Devices: A Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Hansrivijit, Panupong, UPMC Pinnacle, Harrisburg, Pennsylvania, United States
  • Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
  • Kanduri, Swetha Rani, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Mao, Michael A., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

This systematic review and meta-analysis was performed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD).

Methods

A systematic literature search in MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence, and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird.

Results

56 cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis of AKI incidence. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%-30.4%), but rose to 36.9% (95%CI: 31.1%-43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%-15.0%). AKI incidence did not differ significantly between types of LVAD (p = 0.35) or indication for LVAD use (p = 0.62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (P=0.55), the study year was negatively correlated with incidence of severe AKI requiring RRT (slope = -0.068, p <0.001). The pooled odds ratios (ORs) of mortality at 30 days and 1 year in AKI patients were 3.66 (95% CI, 2.00-6.70) and 2.22 (95% CI, 1.62-3.04), respectively. The pooled ORs of mortality at 30 day and 1 year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58-12.33) and 5.41 (95% CI, 3.63-8.06), respectively.

Conclusion

37% of LVAD patients developed AKI based on standard definitions and 13% developed severe AKI requiring RRT. There has been potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1-year mortality.