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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Distinctive kidney function trajectories following left ventricular assist device implantation

Published:September 07, 2022DOI:https://doi.org/10.1016/j.healun.2022.08.024

      Background

      The aim of this study was to assess for distinct kidney function trajectories following left ventricular assist device (LVAD) placement. Cohort studies of LVAD recipients demonstrate that kidney function tends to increase early after LVAD placement, followed by decline and limited sustained improvement. Inter-individual differences in kidney function response may be obscured.

      Methods

      We identified continuous flow LVAD implantations in US adults (2016-2017) from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Primary outcomes were estimated glomerular filtration rate (eGFR) trajectories pre-implantation to ∼12 months. Latent class mixed models were applied to primary and validation samples. Clinical differences among trajectory groups were investigated.

      Results

      Among 4,615 LVAD implantations, 5 eGFR trajectory groups were identified. The 2 largest groups (Groups 1 and 2) made up >80% of the cohort, and were similar to group average trajectories previously reported, with early eGFR rise followed by decline and stabilization. Three novel trajectory groups were found: worsening followed by sustained low kidney function (Group 3, 10.1%), sustained improvement (Group 4, 3.3%), and worsening followed by variation (Group 5, 1.7%). These groups differed in baseline characteristics and outcomes. Group 4 was younger and had more cardiogenic shock and pre-implantation dialysis; Group 3 had higher rates of pre-existing chronic kidney disease, along with older age.

      Conclusions

      Novel eGFR trajectories were identified in a national cohort, possibly representing distinct cardiorenal processes. Type 1 cardiorenal syndrome may have been predominant in Group 4, and parenchymal kidney disease may have been predominant in Group 3.

      KEYWORDS

      Abbreviations:

      LVAD (left-ventricular assist device), INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support), eGFR (estimated glomerular filtration rate), HF (heart failure), BMI (body mass index), BSA (body surface area), ECMO (extracorporeal membrane oxygenation), IABP (intra-aortic balloon pump), VAD (ventricular assist device), BUN (blood urea nitrogen)
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