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Kidney Week

Abstract: PO2417

Baseline Renal Function and Left Ventricular Assist Device Outcomes Among Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Abdulbasit, Muhammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Salameh, Omar Khaleel Mohammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Dauleh, Mujahed Maher Issa, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Miller, Ronald P., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Farooq, Umar, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Trivedi, Naman, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States
Background

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Coronary artery disease is one of the most important causes of heart failure with reduced ejection fraction, a condition for which advanced therapies such as left ventricular assist device (LVAD) and orthotopic heart transplant (OHT) are increasingly utilized. Information about outcomes of CKD patients with LVAD is limited. We studied the outcomes of patients with CKD who had received LVAD in a large cohort.

Methods

We performed a retrospective multi-center cohort study using TriNetX Research Network database, a federated electronic medical records network, to identify 4939 patients≥ 18 years from 31 healthcare organizations, from the United States, who had undergone LVAD implantation between 1/1/2010 and 12/31/2019. We excluded 1552 patients with estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2. We grouped the eligible patients into stages of CKD, based on eGFR: [stages: 2 (n=1140), 3a (n=821), 3b (n=563), 4 (n=182), and 5 (n=681)]. The primary and secondary outcomes were survival and receiving an OHT within one year of LVAD implantation, respectively. We used CKD stage 2 as the reference and calculated the odds ratio (OR) [with 95% confidence interval (CI)] of each of the two outcomes.

Results

A total of 172 patients died within one year of LVAD implantation. When compared with Stage 2 CKD, and after propensity score matching, there was a decrease in the OR of survival at one year with higher stages of CKD:
—Stage 3b: OR: 0.64 (CI: 0.41, 0.99);
—Stage 4: OR: 0.42 (CI: 0.24, 0.73);
—Stage 5: OR: 0.57 (0.38, 0.86).

There was no significant difference in the odds of survival between stage 3a and the reference group.
A total of 274 heart transplants were performed within the first year after LVAD implantation. Patients in the reference group were more likely to receive an OHT within the first year in comparison with CKD stage 5 patients (OR: 1.61; CI: 1.06, 2.45).

Conclusion

Presence of a more advanced stage of CKD is associated with decreased survival in LVAD patients. Patients with CKD stage 2 are more likely to undergo OHT compared to those with CKD stage 5.