TY - JOUR
T1 - Changes in renal function after implantation of continuous-flow left ventricular assist devices
AU - Hasin, Tal
AU - Topilsky, Yan
AU - Schirger, John A.
AU - Li, Zhuo
AU - Zhao, Yanjun
AU - Boilson, Barry A.
AU - Clavell, Alfredo L.
AU - Rodeheffer, Richard J.
AU - Frantz, Robert P.
AU - Edwards, Brooks S.
AU - Pereira, Naveen L.
AU - Joyce, Lyle
AU - Daly, Richard
AU - Park, Soon J.
AU - Kushwaha, Sudhir S.
N1 - Funding Information:
Drs. Hasin, Park, and Kushwaha received an unrestricted grant from Thoratec Corporation for a different unrelated project. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/1/3
Y1 - 2012/1/3
N2 - The aim of this study was to determine renal outcomes after left ventricular assist device (LVAD) implantation. Renal dysfunction before LVAD placement is frequent, and it is unclear whether it is due to primary renal disease or to poor perfusion. A retrospective single-center analysis was conducted in 83 consecutive patients implanted with HeartMate II continuous-flow LVADs (Thoratec Corp., Pleasanton, California). Calculated glomerular filtration rate (GFR) was assessed on admission and 1, 3, and 6 months after implantation. To define predictors for improvement in GFR, clinical variables were examined in patients with decreased renal function (GFR <60 ml/min/1.73 m 2) before LVAD, surviving and dialysis-free at 1 month (n = 44). GFR significantly increased from admission (53.2 ± 21.4 ml/min/1.73 m 2) to 1 month after LVAD implantation (87.4 ± 27.9 ml/min/1.73 m 2) (p < 0.0001). Subsequently, at 3 and 6 months, GFR remained significantly (p < 0.0001) above pre-LVAD values. Of the 51 patients with GFRs <60 ml/min/1.73 m 2 before LVAD surviving at 1 month, 34 (67%) improved to GFRs >60 ml/min/1.73 m 2. Univariate pre-operative predictors for improvement in renal function at 1 month included younger age (p = 0.049), GFR improvement with optimal medical therapy (p < 0.001), intra-aortic balloon pump use (p = 0.004), kidney length above 10 cm (p = 0.023), no treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (p = 0.029), higher bilirubin (p = 0.002), higher Lietz-Miller score (p = 0.019), and atrial fibrillation (p = 0.007). Multivariate analysis indicated pre-operative improved GFR (slope = 0.5 U per unit improved; 95% confidence interval: 0.2 to 0.8; p = 0.003), atrial fibrillation (slope = 27; 95% confidence interval: 8 to 46; p = 0.006), and intra-aortic balloon pump use (slope = 14; 95% confidence interval: 2 to 26; p = 0.02) as independent predictors. In most patients with end-stage heart failure considered for LVAD implantation, renal dysfunction is reversible and likely related to poor renal perfusion.
AB - The aim of this study was to determine renal outcomes after left ventricular assist device (LVAD) implantation. Renal dysfunction before LVAD placement is frequent, and it is unclear whether it is due to primary renal disease or to poor perfusion. A retrospective single-center analysis was conducted in 83 consecutive patients implanted with HeartMate II continuous-flow LVADs (Thoratec Corp., Pleasanton, California). Calculated glomerular filtration rate (GFR) was assessed on admission and 1, 3, and 6 months after implantation. To define predictors for improvement in GFR, clinical variables were examined in patients with decreased renal function (GFR <60 ml/min/1.73 m 2) before LVAD, surviving and dialysis-free at 1 month (n = 44). GFR significantly increased from admission (53.2 ± 21.4 ml/min/1.73 m 2) to 1 month after LVAD implantation (87.4 ± 27.9 ml/min/1.73 m 2) (p < 0.0001). Subsequently, at 3 and 6 months, GFR remained significantly (p < 0.0001) above pre-LVAD values. Of the 51 patients with GFRs <60 ml/min/1.73 m 2 before LVAD surviving at 1 month, 34 (67%) improved to GFRs >60 ml/min/1.73 m 2. Univariate pre-operative predictors for improvement in renal function at 1 month included younger age (p = 0.049), GFR improvement with optimal medical therapy (p < 0.001), intra-aortic balloon pump use (p = 0.004), kidney length above 10 cm (p = 0.023), no treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (p = 0.029), higher bilirubin (p = 0.002), higher Lietz-Miller score (p = 0.019), and atrial fibrillation (p = 0.007). Multivariate analysis indicated pre-operative improved GFR (slope = 0.5 U per unit improved; 95% confidence interval: 0.2 to 0.8; p = 0.003), atrial fibrillation (slope = 27; 95% confidence interval: 8 to 46; p = 0.006), and intra-aortic balloon pump use (slope = 14; 95% confidence interval: 2 to 26; p = 0.02) as independent predictors. In most patients with end-stage heart failure considered for LVAD implantation, renal dysfunction is reversible and likely related to poor renal perfusion.
KW - assist device
KW - heart failure
KW - outcome
KW - predictors
KW - renal dysfunction
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U2 - 10.1016/j.jacc.2011.09.038
DO - 10.1016/j.jacc.2011.09.038
M3 - Article
C2 - 22192665
AN - SCOPUS:84055172780
SN - 0735-1097
VL - 59
SP - 26
EP - 36
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -