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Kidney Week

Abstract: PO0191

Predictors and Outcomes of Post-Left Ventricular Assist Device AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Salameh, Omar Khaleel Mohammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Abdulbasit, Muhammad, 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
  • Kaur, Gurwant, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States
Background

Left ventricular assist device (LVAD) is used to treat advanced heart failure as a bridge to orthotopic heart transplant (OHT) or as destination therapy in patients who are not OHT candidates. With limited donor availability and significant improvement in LVAD outcomes, the number of patients with LVAD implantation as destination therapy has increased. With increased LVAD use, the number of adverse events and complications are expected to increase. Acute kidney injury (AKI) is a frequent complication after LVAD implantation and is associated with high mortality. We studied the predictors of Post-LVAD AKI and the association between AKI and mortality, as well as between AKI and receiving an OHT.

Methods

We conducted a retrospective multi-center study using TriNetX Research Network database, a federated electronic medical records, to identify 486 patients from 24 healthcare organizations from the United States, with no underlying chronic kidney disease (CKD) who had an LVAD implanted between 1/1/2010 and 12/31/2019. Of these, 116 (23.9%) had developed AKI within the first month of the procedure. The baseline characteristics of this group were compared with the 370 patients who had not developed AKI during the first month after LVAD placement.

Results

There was no statistically significant difference between the two groups in regards to age at time of LVAD placement, sex, or ethnicity. Black race was associated with a higher odds of developing AKI (Odds Ratio [OR]: 1.70; 95% Confidence Interval [CI]: 1.11, 2.59). The two co-morbidities most significantly associated with AKI during the first month after LVAD placement were: persistent atrial fibrillation (OR: 3.33; CI: 1.35, 8.22), and a body mass index (BMI) > 50 (OR: 3.86; CI: 2.21, 6.75). During the first year after LVAD placement, 73 patients died and 37 patients received OHT. There was no statistical difference in one-year mortality or likelihood of undergoing an OHT within a year between the AKI and non-AKI groups.

Conclusion

In patients with no underlying CKD, black race, persistent atrial fibrillation, and BMI above 50 increase the likelihood of post-LVAD AKI. Development of AKI post-LVAD implantation in these patients is not associated with changes in one-year mortality or likelihood of receiving an OHT.