Kidney Week

Abstract: FR-PO0073

Predictors of Post-Left Ventricular Assist Device Kidney Recovery in Patients with End-Stage Heart Failure and Kidney Dysfunction

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Park, Jeehyang, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jeehyang Park, MD

• Song, Seungmin, Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University of Medicine, Seoul, Korea (the Republic of)

Seungmin Song, MD

• Jeon, Junseok, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Jang, Hye Ryoun, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

• Lee, Jung eun, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Lee, Kyungho, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Kyungho Lee, MD, PhD

Background

Renal dysfunction is common in patients with end-stage heart failure or cardiogenic shock due to cardiorenal syndrome (CRS), often with unclear baseline kidney function. Predicting renal recovery following left ventricular assist device (LVAD) surgery remains difficult. This study aimed to identify clinical predictors of renal recovery after LVAD placement in those with pre-existing renal impairment.

Methods

We analyzed patients with impaired kidney function (defined as creatinine-based eGFR <60mL/min/1.73m²) or under renal replacement therapy (RRT) who underwent HeartMate 3 LVAD implantation at a tertiary referral academic hospital in Korea between 2020 and 2024. Patients were categorized into recovery and non-recovery groups. Renal recovery was defined as a ≥50% increase in eGFR or liberation from RRT. Logistic regression analysis was used to identify predictive factors.

Results

Among a total of 113 patients who underwent LVAD, 77 patients had pre-existing kidney dysfunction, including 43 patients with reduced eGFR (<60 mL/min/1.73m²) and 34 patients under RRT. The median age was 64.0 (IQR 54.0–71.0) years, and the cohort was predominantly male (83.1%). Renal recovery rates at 1, 2, 3, and 6 months after LVAD implantation were 64.9%, 77.9%, 81.8%, and 81.8%, respectively. Notably, no additional recovery was observed beyond 3 months in patients who did not show earlier improvement. After adjusting multiple covariates, predictive factors for renal recovery at 1 month were younger age (OR 0.74/year increase, 95% CI 0.59–0.92), use of renin-angiotensin system (RAS) blockers (OR 23.81, 95% CI 2.02–607.88), and absence of proteinuria (OR 0.02, 95% CI 0.01–0.21), and presence of tricuspid regurgitation (OR 29.69, 95% CI 3.01–626.73) before surgery. Preoperative RAS blocker use and presence of tricuspid regurgitation remained independent predictors of renal recovery at 2 and 3 months after LVAD implantation

Conclusion

For patients with pre-existing renal impairment, withholding RAS blockade, a component of guideline-directed medical therapy, may adversely affect renal recovery following LVAD implantation. Furthermore, pre-LVAD tricuspid regurgitation may serve as a contributing factor or a marker of reversible CRS in this population.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025fjjy8m6m