Abstract: PUB013
Effect of Mechanical Circulatory Support on Kidney and Electrolyte Outcomes in Cardiogenic Shock: A Multinational, Real-World Cohort Study
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Matarneh, Ahmad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Sardar, Sundus, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Obaed, Nadia Grace, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Akkari, Abdel-Rauof M., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Salameh, Omar Khaleel Mohammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Abdulbasit, Muhammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Verma, Navin, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Ghahramani, Nasrollah, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
Background
Mechanical circulatory support (MCS), including left and right ventricular assist devices (LVAD/RVAD) and extracorporeal membrane oxygenation (ECMO), is increasingly used in the management of cardiogenic shock (CS). However, its association with renal and metabolic complications remains poorly characterized in large-scale real-world populations.
Methods
We analyzed data from the TriNetX Global Collaborative Network, comprising 148 healthcare organizations. Adult patients (≥18 years) with a diagnosis of cardiogenic shock (ICD-10: R57.0) were identified between 2005 and 2025. Patients who received MCS (ECMO, LVAD, or RVAD; Cohort A) were compared to those without MCS (Cohort B). Outcomes included mortality, acute kidney injury (AKI), end-stage renal disease (ESRD), need for continuous renal replacement therapy (CRRT), and electrolyte disturbances. Odds ratios (ORs), hazard ratios (HRs), and Kaplan-Meier survival analyses were performed. No propensity matching was applied.
Results
Cohort A included 15,590 patients with CS who received MCS; Cohort B included 237,947 CS patients without MCS.
Key findings
Mortality: 49.7% vs. 44.6% (OR 1.22; p<0.001)
AKI: 53.9% vs. 38.7% (OR 1.85; HR 1.42; p<0.001)
ESRD: 13.3% vs. 8.9% (OR 1.57; p<0.001)
CRRT: 0.4% vs. 0.2% (OR 2.71; p<0.001)
Hyponatremia: 21.3% vs. 14.8% (OR 1.56; HR 1.36; p<0.001)
Hypernatremia: 11.9% vs. 5.5% (OR 2.30; HR 2.00; p<0.001)
Hypocalcemia: 7.8% vs. 3.9% (OR 2.10; p<0.001)
Hyperkalemia: 22.7% vs. 14.7% (OR 1.71; p<0.001)
Hypokalemia: 24.1% vs. 15.5% (OR 1.73; p<0.001)
Hyperphosphatemia: 13.2% vs. 6.7% (OR 2.10; p<0.001)
Kaplan-Meier curves showed significantly shorter survival and earlier onset of renal and electrolyte complications in the MCS group.
Conclusion
Among patients with cardiogenic shock, the use of mechanical circulatory support is associated with increased risks of AKI, ESRD, CRRT, and a broad spectrum of electrolyte disturbances. These findings highlight the need for early nephrology involvement and stringent metabolic monitoring in CS patients receiving MCS.