Concurrent use of kidney replacement therapy and temporary left ventricular assist device in cardiogenic shock: A systematic review and meta-analysis.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-06-18 DOI:10.1159/000546854

Oliver Lim, Kamalesh Anbalakan, Ryan Ruiyang Ling, Bryan Tan, Vivien Mak, Ying Chen, Manish Kaushik, Matthew Jose Chakaramakkil, Kollengode Ramanathan

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引用次数: 0

Abstract

Background: The use of temporary left ventricular assist devices (T-LVADs) for circulatory support in cardiogenic shock is increasing along with complications like acute kidney injury requiring kidney replacement therapy (KRT). While KRT is linked to mortality in cardiogenic shock, data on mortality in patients receiving both T-LVAD and KRT is limited.

Methods: We conducted a systematic review and meta-analysis, searching three databases from inception through 30 December 2023 for studies reporting on patients with concurrent T-LVAD and KRT support during cardiogenic shock. We performed random effects meta-analyses, looking at in-hospital mortality as our primary outcome. Subgroup analysis was performed based on the continent, timing of KRT, and type of T-LVAD. Risk of bias was assessed with the Joanna Briggs Institute checklists and certainty of evidence with the GRADE approach.

Results: We included 35 studies after screening through 89 full-text articles, consisting of 2277 individuals receiving T-LVAD and 722 (30.9%, 95% CI: 25.8-36.6) receiving concurrent KRT. In-hospital mortality was pooled across six studies, with 91 non-survivors (65.5%) amongst 139 individuals (95% CI: 57.2-72.9). Concurrent KRT and T-LVAD was associated with higher in-hospital (OR 3.48, 95% CI: 2.20-5.49) and overall mortality (OR 2.19, 95% CI 1.01-4.76) compared to patients not on KRT. The proportion of patients on KRT were significantly (pinteraction=0.0004) larger in Europe (37.2%, 95% CI: 32.2-42.4) than North America (18.2%, 95% CI: 12.0-26.7). Region, type of T-LVAD and publication year did not significantly impact any of the mortality outcomes.

Conclusion: Patients on concurrent KRT and T-LVAD suffer significantly greater odds of mortality compared to patients not receiving KRT during their hospital admission. A substantial proportion of patients receiving T-LVADs require KRT. Further studies with head-to-head comparisons between KRT and non-KRT treatment arms are warranted to confirm our findings, in addition to identifying at-risk populations that require KRT and potential interventions to improve survival in this subset of patients.

查看原文本刊更多论文

在心源性休克中同时使用肾脏替代疗法和临时左心室辅助装置：一项系统回顾和荟萃分析。

背景：在心源性休克中，临时左心室辅助装置（t - lvad）用于循环支持的使用随着急性肾损伤需要肾脏替代治疗（KRT）等并发症的增加而增加。虽然KRT与心源性休克的死亡率有关，但同时接受T-LVAD和KRT的患者死亡率的数据有限。方法：我们进行了系统回顾和荟萃分析，检索了三个数据库，从建立到2023年12月30日，报告了心源性休克期间并发T-LVAD和KRT支持的患者。我们进行了随机效应荟萃分析，将住院死亡率作为我们的主要结果。根据KRT的大陆、时间和T-LVAD类型进行亚组分析。采用乔安娜布里格斯研究所的检查表和GRADE方法的证据确定性来评估偏倚风险。结果：在筛选89篇全文文章后，我们纳入了35项研究，包括2277名接受T-LVAD的个体和722名（30.9%,95% CI: 25.8-36.6）接受同时KRT的个体。住院死亡率汇集在6项研究中，139名患者中有91名非幸存者（65.5%）（95% CI: 57.2-72.9）。与未接受KRT的患者相比，同时接受KRT和T-LVAD的患者住院率（OR 3.48, 95% CI: 2.20-5.49）和总死亡率（OR 2.19, 95% CI 1.01-4.76）较高。接受KRT治疗的患者比例在欧洲（37.2%,95% CI: 32.2-42.4）显著高于北美（18.2%,95% CI: 12.0-26.7）（p相互作用=0.0004）。地区、T-LVAD类型和发表年份对死亡率无显著影响。结论：与住院期间未接受KRT治疗的患者相比，同时接受KRT和T-LVAD治疗的患者死亡率明显更高。很大一部分接受t - lvad的患者需要KRT。除了确定需要KRT治疗的高危人群和潜在的干预措施以提高这部分患者的生存率外，还需要进一步研究KRT治疗组和非KRT治疗组之间的正面比较来证实我们的发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.