Changes in renal function after implantation of continuous-flow left ventricular assist devices

Tal Hasin, Yan Topilsky, John A. Schirger, Zhuo Li, Yanjun Zhao, Barry A. Boilson, Alfredo L. Clavell, Richard J. Rodeheffer, Robert P. Frantz, Brooks S. Edwards, Naveen L. Pereira, Lyle Joyce, Richard Daly, Soon J. Park, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

112 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)26-36
Number of pages11
JournalJournal of the American College of Cardiology
Volume59
Issue number1
DOIs
StatePublished - Jan 3 2012

Keywords

  • assist device
  • heart failure
  • outcome
  • predictors
  • renal dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Hasin, T., Topilsky, Y., Schirger, J. A., Li, Z., Zhao, Y., Boilson, B. A., Clavell, A. L., Rodeheffer, R. J., Frantz, R. P., Edwards, B. S., Pereira, N. L., Joyce, L., Daly, R., Park, S. J., & Kushwaha, S. S. (2012). Changes in renal function after implantation of continuous-flow left ventricular assist devices. Journal of the American College of Cardiology, 59(1), 26-36. https://doi.org/10.1016/j.jacc.2011.09.038