Impact of Continuous Flow Left Ventricular Assist Device Therapy on Chronic Kidney Disease: A Longitudinal Multicenter Study

• Published in: Journal of cardiac failure 2020-04, Vol.26 (4), p.333-341
• Main Authors: Yalcin, Yunus C., Muslem, Rahatullah, Veen, Kevin M., Soliman, Osama I., Hesselink, Dennis A., Constantinescu, Alina A., Brugts, Jasper J., Manintveld, Olivier C., Fudim, Marat, Russell, Stuart D., Tomashitis, Brett, Houston, Brian A., Hsu, Steven, Tedford, Ryan J., Bogers, Ad J.J.C., Caliskan, Kadir
• Format: Article
• Language: English
• Subjects: chronic kidney disease; end-stage heart failure; Left ventricular assist device; renal improvement
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.01.010

•Left ventricular assist device implantation improves early renal function in the majority of patients.•Subsequent to improvement, renal function regresses to preoperative values.•Early renal function improvement is associated with worse preoperative conditions.•Early renal function is associated with increased 2-year survival rates.•Sustained renal function improvement is present in a small percentage of patients. Many patients undergoing durable left ventricular assist device (LVAD) implantation suffer from chronic kidney disease (CKD). Therefore, we investigated the effect of LVAD support on CKD. A retrospective multicenter cohort study, including all patients undergoing LVAD (HeartMate II (n = 330), HeartMate 3 (n = 22) and HeartWare (n = 48) implantation. In total, 227 (56.8%) patients were implanted as bridge-to-transplantation; 154 (38.5%) as destination therapy; and 19 (4.7%) as bridge-to-decision. Serum creatinine measurements were collected over a 2-year follow-up period. Patients were stratified based on CKD stage. Overall, 400 patients (mean age 53 ± 14 years, 75% male) were included: 186 (46.5%) patients had CKD stage 1 or 2; 93 (23.3%) had CKD stage 3a; 82 (20.5%) had CKD stage 3b; and 39 (9.8%) had CKD stage 4 or 5 prior to LVAD implantation. During a median follow-up of 179 days (IQR 28–627), 32,629 creatinine measurements were available. Improvement of kidney function was noticed in every preoperative CKD-stage group. Following this improvement, estimated glomerular filtration rates regressed to baseline values for all CKD stages. Patients showing early renal function improvement were younger and in worse preoperative condition. Moreover, survival rates were higher in patients showing early improvement (69% vs 56%, log-rank P = 0 .013). Renal function following LVAD implantation is characterized by improvement, steady state and subsequent deterioration. Patients who showed early renal function improvement were in worse preoperative condition, however, and had higher survival rates at 2 years of follow-up.