The impact of preoperative kidney replacement therapy on kidney outcome and survival in patients with left ventricular assist device

Abstract

Left ventricular assist device (LVAD) has been highlighted as a new treatment option in the end-stage heart failure (HF). Kidney outcome after LVAD in severe cardiorenal syndrome (CRS) patients requiring kidney replacement therapy (KRT) is unclear. We investigated the impact of preoperative KRT on kidney function and survival in LVAD patients with severe CRS. A total of 50 patients followed up for at least 1 year after LVAD implantation was analyzed. The primary outcomes were estimated glomerular filtration rate and survival rate. Patients were divided into two groups depending on in-hospital KRT before LVAD implantation: the control group (n = 33) and the KRT group (n = 17). Postoperative KRT was performed for 76.5% of patients in the KRT group, and all of them discontinued KRT before discharge. There were no statistically significant differences in the degree of eGFR decline in survivors according to preoperative KRT. Although there were no statistically significant differences in the degree of eGFR decline in survivors regardless of preoperative KRT, old age (β −0.94, p < 0.01), preexisting chronic kidney disease (β −21.89, p < 0.01), and high serum creatinine (β −13.95, p < 0.01) were identified as independent predictors of post-LVAD eGFR decline. Mortality rate was higher, and more patients progressed to end-stage kidney disease in KRT group than control group. However, LVAD still can be considered as the treatment option in end-stage HF patients with severe CRS requiring KRT, especially in those with young age and previous normal kidney function.

Keywords:

• Cardiorenal syndrome
• heart failure
• left ventricular assist device
• kidney function

Acknowledgments

The authors would like to thank the KRT nursing team and transplantation team of Samsung Medical Center for their dedicated effort.

Author contributions

H.J., J.J., and H.R.J. designed the study. H.J., J.J., and D.K. analyzed the data. H.J., J.J., D.K., Y.H.C., J.E.L., J.C., W.H., Y.K., E.J., and H.R.J. interpreted the data. H.J. and H.R.J. wrote the manuscript. K.L., J.J., and H.R.J. revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC20C0085).