Abstract: PO1802
Kidney Function Trajectory Following Left Ventricular Assist Device Implantation
Session Information
- Hypertension and CVD: Clinical, Outcomes, and Trials
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States
- Benoit, Julia, University of Houston, Houston, Texas, United States
- Lamba, Harveen, Baylor College of Medicine, Houston, Texas, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background
LVADs have variable effects on kidney function. Identification of distinctive eGFR trajectory groups after LVAD placement, by applying unsupervised techniques to longitudinal eGFR measures, may enable insights into diverse pathophysiology.
Methods
From a national cohort, we identified persons who underwent isolated, primary continuous flow LVAD implantation in the US, 2016-17. eGFR values from pre-LVAD implantation to 12 months post were used. Latent class mixed models using cubic splines were applied to derivation and validation subsets, and models with 2-9 distinct groups were evaluated to find the optimal number.
Results
In the cohort (3,461 in derivation subset, 1,154 in validation), we identified 5 distinct trajectory groups. The 2 largest groups (1,2) are similar to previously reported cohort averages, with early eGFR increase followed by decline, but differed by baseline eGFR. Three smaller groups (3-5, ~15% of the cohort) demonstrated novel trajectories: group 3 had early worsening with sustained low kidney function; 4 had early and sustained eGFR improvement, and 5 had substantial eGFR variation. These groups differed in baseline factors (groups 3 and 4 had the most pre-LVAD acute dialysis, 4 and 5 the most cardiogenic shock) and outcomes (groups 2 and 4 had the highest survival, 3 and 5 had the lowest).
Conclusion
Novel eGFR trajectories after LVAD implantation were identified in a national cohort. Group 4, with early and sustained increase in eGFR, may reflect type 1 cardiorenal syndrome. Group 3 may reflect chronic kidney disease with early complications, and group 5 may reflect intact kidney parenchyma but post-LVAD right ventricular failure. These results demonstrate the feasibility of identifying previously unobserved heterogeneity in kidney outcomes. The novel trajectory groups may reveal potential for tailored care, in addition to pathophysiologic insights.
Trajectory groups. Bold lines are class-specific predicted means; thin lines are individuals
Funding
- NIDDK Support