Renal Recovery After Replacement Therapy During CF LVAD Support

Cruz, Mary D.; Saeed, Omar; Rangasamy, S.; Katsa, Ioanna; Fertel, J.; Selevany, Ibrahim; Patel, Snehal R.; Sims, Daniel B.; Shin, J.; Goldstein, Daniel J.; Jorde, Ulrich P.

doi:10.1016/j.healun.2017.01.253

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“…Early improvement in kidney function in patients with AKI after LVAD placement is associated with decreased length of stay and fewer complications [ 14 ]. Kidney recovery is associated with a favorable prognosis in estimating postoperative kidney function in adults and children undergoing LVAD placement [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A meta-analysis

Kovvuru¹,

Kanduri²,

Vallabhajosyula³

et al. 2021

WJCCM

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BACKGROUND Acute kidney injury (AKI) is a common and severe complication after left ventricular assist device (LVAD) implantation with an incidence of 37%; 13% of which require kidney replacement therapy (KRT). Severe AKI requiring KRT (AKI-KRT) in LVAD patients is associated with high short and long-term mortality compared with AKI without KRT. While kidney function recovery is associated with better outcomes, its incidence is unclear among LVAD patients with severe AKI requiring KRT. AIM To identify studies evaluating the recovery rates from severe AKI-KRT after LVAD placement, which is defined by regained kidney function resulting in the discontinuation of KRT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies. METHODS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate ( P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses. RESULTS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate ( P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses. CONCLUSION Recovery from severe AKI-KRT after LVAD occurs approximately 50.5%, and it has not significantly changed over the years despite advances in medicine.

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Section: Introductionmentioning

confidence: 99%