A Large Single-Center StudyLeft ventricular assist device (LVAD) C irculatory support with left ventricular assist devices (LVADs) has emerged as a powerful therapy that can improve outcomes in patients who have advanced heart failure (HF) refractory to medical therapy.1-3 The scarcity of donor organs severely limits transplantation as an option for patients with advanced HF; moreover, transplant patients need lifelong immunosuppression, the medications for which can have their own serious side effects. The newest generation of LVADs comprises continuous-flow (CF) pumps, which use axial or centrifugal technology, deliver flows of up to 10 L/min, 2,4 and are smaller and more durable than previous models. Currently, these LVADs are implanted either as a bridge to transplantation (BTT) or as destination therapy (DT), which offers a permanent alternative to transplantation.Recently, patients with end-stage HF were given new options when the U.S. Food and Drug Administration (FDA) approved 2 continuous-flow LVADs: the HeartMate ® II (Thoratec Corporation; Pleasanton, Calif ) and the HeartWare ® Ventricular Assist System (HeartWare Inc.; Framingham, Mass). The HeartMate II was approved for BTT in 2008 and for DT in 2010, and the HeartWare was approved for BTT in 2012. These milestones initiated modern LVAD therapy, enabling this treatment to become available to a larger population of patients. [5][6][7][8][9] Consequently, LVAD use has dramatically increased throughout the world, particularly for DT, and growing numbers of medical centers are offering device therapy. [9][10][11] This trend has been bolstered by reports that LVAD use, in HF patients 70 years of age or older, is associated with

Background Similar to coronary angiography and interventions, patients undergoing percutaneous treatment of lower extremity peripheral arterial disease are also at risk of acute kidney injury (AKI). The incidence, risk factors associations, need for dialysis and inhospital mortality related to AKI in patients with critical limb ischemia (CLI) following endovascular therapy is poorly defined. Objectives The purpose of this study was to analyze data from the National Inpatient Sample (NIS) to determine the aforementioned outcomes in patients with CLI. Methods Using the full NIS admission dataset from 2003 through 2012, ICD‐9 codes relevant to comorbid conditions, procedure codes, composite codes for AKI, and inhospital mortality were analyzed using multivariate models. Results A total of 273,624 patients were included with a mean age of 70.0 ± 27.4 years, 46.0% were female, 57.2% had diabetes, 43.4% had coronary artery disease (CAD), and 29.2% had chronic kidney disease (CKD). The overall rate of AKI was 10.4%, and there was a temporal rise over the analysis period in AKI incidence (p < .001). Age, diabetes, CKD, and heart failure were all associated with AKI (p < .0001). The inhospital mortality rate in the patients with AKI declined over time but was higher than in patients without AKI (6.0% vs. 1.4%), p < .0001. The mortality rate was substantially higher in patients with AKI requiring dialysis as compared to AKI not requiring dialysis (13.4% vs. 5.6%), p < .0001. Conclusions AKI is associated with age, CKD, and heart failure. The incidence of AKI following endovascular therapy for CLI is rising and independently associated with inhospital mortality.

Introduction: Patients undergoing endovascular therapy (EVT) for lower extremity peripheral arterial disease (PAD) are at risk for acute kidney injury (AKI). The purpose of this study was to determine the incidence, risk factors, and outcomes of AKI in the context of EVT from the National Inpatient Sample (NIS). Methods: Patient admissions in the NIS were queried from 2003-2012. The admissions were limited to non-dialysis patients with either critical limb ischemia (CLI) or claudication undergoing either EVT and/or angiography. AKI was defined using a composite of ICD-9 codes which have been previously validated in this context. Available comorbidity data, demographics, and inpatient outcomes (AKI, mortality) were analyzed using multivariable logistic regression models with age expressed in decades. Results: 552,484 admissions for CLI and 441,736 for claudication were included. The incidence of AKI is shown in the figure. The multivariate predictors of AKI in patients with claudication undergoing EVT only included age (OR 1.05, CI [1.02-1.09], P<0.001), female gender (OR 1.1, CI [1.01-1.15], P=0.03), heart failure (OR 2.8, CI [2.6-3.1], P<0.001), chronic kidney disease (CKD) (OR 6.5, CI [6.0-7.1], P<0.001), and diabetes (OR 1.1, CI [1.05-1.2], P=0.001). A similar analysis for CLI patients revealed the following predictors: age (OR 1.1, CI [1.09-1.12], P<0.001), heart failure (OR 2.1, CI [2.05-2.22], P<0.001), CKD (OR 2.8, CI [2.7-2.9], P<0.001), diabetes (OR 1.2, CI [1.1-1.2], P<0.001), and stroke (OR 1.6, CI [1.45-1.7], P<0.001). AKI was an independent predictor of mortality in patients undergoing EVT with either claudication (OR 17.8 [15.5, 20.5], P<0.001) or CLI (OR 4.6 [4.2, 4.9], P<0.001). Conclusions: AKI occurs in approximately 3.5% of patients undergoing endovascular procedures for claudication and 10.9% in CLI patients. CKD and heart failure are the strongest risk factors for AKI. AKI is an independent predictor of inpatient mortality.

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