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Kidney Week

Abstract: PO0089

Recovery of Renal Function Among Left Ventricular Assist Device Patients with Severe AKI Requiring Renal Replacement Therapy: A Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kanduri, Swetha Rani, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Kovvuru, Karthik, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Vaitla, Pradeep, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Thongprayoon, Charat, Mayo Clinic Rochester, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic Rochester, Rochester, Minnesota, United States
Background

Acute kidney injury (AKI) is a common and severe complication after left ventricular assist devices (LVAD) implantation with an incidence of 37%; 13% of which requiring renal replacement therapy (RRT). Severe AKI requiring RRT in LVAD patients is associated with high short-term and long-term mortality, compared with those without RRT. While recovery of renal function is associated with better outcomes, the rates of recovery of renal function among LVAD patients with severe AKI requiring RRT are unclear.

Methods

Ovid MEDLINE, EMBASE, and the Cochrane Databases were systemically searched from database inceptions through January 2020 to identify studies evaluating the rates of recovery from severe AKI requiring RRT after LVAD placement, which is defined by regained kidney function resulting in the discontinuation of RRT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies.

Results

A total of 268 patients from 14 cohort studies with severe AKI requiring RRT after LVAD were enrolled. Follow-up time ranges from hospital discharge up to 12 months. 78.5% of renal recovery occurred at the time of hospital discharge or within 30 days. Majority (85%) of patients used continuous-flow LVAD. Overall, the pooled estimated rates of AKI recovery among patients with severe AKI requiring RRT was 50.5% (95%CI: 34.0%-67.0%), respectively. While the data on pulsatile-flow LVAD were limited, subgroup analysis of continuous-flow LVAD demonstrated the pooled estimated rates of AKI recovery among patients with severe AKI requiring RRT of 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not demonstrate a significant association between study year and AKI recovery rate (p = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.

Conclusion

Recovery from severe AKI requiring RRT after LVAD occurs approximately 50.5%, and it has not significantly changed over the years despite advances in medicine.