Major adverse kidney events predict reduced survival in ventricular assist device supported patients
Publication Details
Barua, S.,
Conte, S. M.,
Cherrett, C.,
Kearney, K.,
Robson, D.,
Bragg, C.,
Macdonald, P.,
Muthiah, K.,
&
Hayward, C.
(2023).
Major adverse kidney events predict reduced survival in ventricular assist device supported patients.
ESC Heart Failure,.
Abstract
Aims: There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assistdevices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectoryin VAD supported patients.
Methods and results: We conducted a single-centre retrospective analysis of consecutive VAD implants between 2010 and2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE wasdefined as thefirst event to occur of sustained drop (>50%) in estimated glomerularfiltration rate (eGFR), progression tostage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or deathon renal replacement therapy at any time. One-hundred and seventy-three patients were included, median age 56.8 years,18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty-seven patients experienced MAKE. On multivariate analysis,post-implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocyteson bloodfilm analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88,P<0.001 andadjusted odds ratio 3.33,P= 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80,P<0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3-month improvement ineGFR, seen in other cohorts.
Conclusions: MAKE significantly impacts survival. In our cohort, MAKE was predicted by post-implant right ventricular failureand chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE.
Keywords
Major adverse kidney events, Survival, Ventricular assist device
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