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Improvement in Kidney Function After Ventricular Assist Device Implantation and Its Influence on Thromboembolism, Hemorrhage, and Mortality

Davis, Brittney H.*; Boehme, Amelia K.; Pamboukian, Salpy V.; Allon, Michael§; George, James F.; Dillon, Chrisly*; Kirklin, James K.; Tallaj, Jose; Levitan, Emily B.; Griffin, Russell; McGwin, Gerald Jr; Beasley, T. Mark#; Limdi, Nita A.*,‖

doi: 10.1097/MAT.0000000000000989
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Although heart transplantation remains the gold standard for management of heart failure, ventricular assist devices (VAD) have emerged as viable alternatives. VAD implantation improves kidney function. However, whether the improvement is sustained or associated with improved outcomes is unclear. Herein we assess kidney function improvement, predictors of improvement, and associations with thromboembolism, hemorrhage, and mortality in VAD patients. Kidney function was defined using chronic kidney disease (CKD) stages: stage 1 (glomerular filtration rate [eGFR] ≥ 90 ml/min/1.73 m2), stage 2 (eGFR 60–90 ml/min/1.73 m2), stage 3a (eGFR 45–59 ml/min/1.73 m2), stage 3b (eGFR 30–44 ml/min/1.73 m2), stage 4 (eGFR 15–30 ml/min/1.73 m2), and stage 5 (eGFR < 15 ml/min/1.73 m2). Improvement in kidney function was defined as an improvement in eGFR that resulted in a CKD stage change to one of lesser severity. Kidney function improved post implant, and was maintained over 1 year for all patients, except those with baseline stage 5 CKD. Younger age at implantation (OR 0.93, 95% CI: 0.90–0.96, P < 0.0001) was associated with sustained improvement in kidney function. Poor kidney function was associated increased mortality but not with thromboembolism or hemorrhage. Compared to patients with baseline eGFR > 45 ml/min/1.73 m2; patients with eGFR < 45 ml/min/1.73 m2 had a higher mortality risk (HR 3.32, 95% CI: 1.10–9.98, p = 0.03 for stage 3b; HR 4.07, 95% CI: 1.27–13.1, p = 0.02 for stage 4; and HR 4.01, 95% CI: 1.17–13.7, p = 0.03 for stage 5 CKD). Kidney function was not associated with thromboembolism or hemorrhage, and sustained improvement was not associated with lower risk of death. However, poor kidney function at implantation was associated with an increased risk of mortality.

From the *Department of Neurology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Department of Neurology, Columbia University, New York

Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

§Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama

#Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.

Submitted for consideration September 2018; accepted for publication in revised form February 2019.

Disclosure: The authors have no conflicts of interest to report.

This work was supported in part by the American Heart Association (Award No. 13PRE13830003) and the National Institute of Health (RO1HL092173; K24HL133373, and T32HG008961). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHA and NIH.

Brittney H. Davis and Amelia K. Boehme contributed equally to this work.

Correspondence: Brittney H. Davis, Department of Neurology, Jefferson Tower 1235, 619 19th Street South, Birmingham, AL 35294-0022. Email: brittneydavis@uabmc.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs