3 years ago

Renal Function Changes Following Left Ventricular Assist Device Implantation

Limited data are available assessing the long-term clinical significance of post-LVAD implantation changes in renal function, particularly in patients with baseline glomerular filtration rate (GFR) < 45 mL/min/1.73 m2. We aimed to investigate the impact of changes in renal function after left ventricular assist device (LVAD) implantation on subsequent long-term outcomes. We followed 184 patients with HeartMate II LVADs implanted between May 2008 and November 2014. Serial assessment of renal function, using categorized GFR, was performed at baseline and at day 1, day 7, 1 month, 3 months, 6 months, 1 year, and 2 years after implantation. Effects of 1-month GFR and changes in GFR from baseline to 1 month on long-term mortality and hospital re-admission were evaluated. There were 30 patients with GFR<45 (low), 44 with GFR 45-59 (intermediate), and 110 with GFR≥60 (normal) at baseline. Only patients with baseline GFR<45 experienced significant improvement in GFR after 2 years of follow-up (p=0.012). At 1 month, a higher GFR category was significantly associated with a 31% reduction in mortality (HR=0.69, CI=0.49-0.98, p=0.036), but not re-admission. Patients with baseline low and intermediate GFR who had no improvement in renal function category at 1 month experienced significantly greater risk of mortality (HR=1.95, CI=1.10-3.43, p=0.022) and re-admission (HR=1.75, CI=1.07-2.84, p=0.025), relative to patients whose GFR was normal at baseline and 1 month. In conclusion, renal function after LVAD implantation improves in patients with GFR<45. Change in renal function from baseline to 1 month post-implantation is a powerful marker of long-term outcomes.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917314625

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