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Abstract: FR-PO110

Right Heart Failure and Reduced Kidney Function in Left Ventricular Assist Device Recipients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background

Right heart failure (RHF) and kidney dysfunction are harmful complications of left ventricular assist devices (LVADs). RHF can cause kidney dysfunction through elevated renal venous pressure. We investigated the time-varying relationship of RHF with reduced kidney function in a national cohort of LVAD recipients.

Methods

We identified implantations of isolated continuous flow LVADs from 2016-17 in INTERMACS, a national registry. RHF was ascertained from the binary right heart failure variable in INTERMACS, an adjudicated variable based on persistent signs and symptoms of RHF. Multistate Markov models were used to analyze the relationship between time-varying RHF state and reduced kidney function (defined as eGFR <30 ml/min/1.73m2 or dialysis) over 14 months following LVAD implantation (censoring for heart transplant, LVAD removal, or death). Piecewise models were used, to account for varying baseline risk of reduced kidney function during follow-up, with cut points at 1 week and 1, 3, and 6 months.

Results

We identified 4,616 LVAD implantations. Median age was 59 years and 21% were female. There were 313 state changes to RHF and 752 state changes to reduced kidney function over 3,043 person-years. Risk for development of reduced kidney function, and prevalences of reduced kidney function and RHF, were highest early after LVAD implantation but remained substantial throughout follow-up (Figure). RHF was associated with higher risk of development of reduced kidney function: HR 2.93 (95% CI 2.18-3.94).

Conclusion

We found that RHF is associated with nearly 3 fold higher risk of development of reduced kidney function among LVAD recipients in a national cohort, with highest risk early after LVAD implantation. This demonstrates the importance of right heart function and renal venous pressure to kidney function in advanced heart failure and durable mechanical circulatory support.

Funding

  • NIDDK Support