Acute kidney injury and chronic kidney disease after left ventricular assist device placement

Objective

Left ventricular assist device (LVAD) implantation may lead to acute kidney injury (AKI), but LVAD therapy increases cardiac output and may reverse cardiorenal syndrome. We conducted this study to test the hypothesis that AKI after LVAD implantation is associated with glomerular filtration rate (eGFR) decline and chronic kidney disease (CKD) stage progression.

Methods

We included all patients undergoing LVAD implantation between August 2011 and August 2021 at a high-volume LVAD center. AKI was quantified using Kidney Disease: Improving Global Outcomes criteria. We estimated eGFR before and 30, 60, 90, and 365 days after LVAD implantation to stage CKD. We measured the associations between AKI and eGFR, adjusting for potential confounders and risk factors.

Results

One hundred ninety-one of the 482 subjects (39.6%) developed postoperative AKI. Overall, median eGFR change (25th, 75th percentile) was −5.9% (−22.3%, 15.6%) at 90 days after LVAD and −17.2% (−36.9%, 5.1%) at 1 year. In subjects who developed AKI, eGFR declined 11.7% (95% confidence interval, 4.2%-19.1%; P = .002) more at 90 days, more patients progressed to a greater stage of CKD, and death was 2.4-fold (95% confidence interval, 1.6-3.5; P < .001) greater at 1 year than in subjects without postoperative AKI. Subjects with more advanced baseline CKD had less eGFR decline than subjects with less advanced baseline CKD.

Conclusions

Among patients receiving LVAD therapy, AKI and eGFR decline were common, and postoperative AKI was independently associated with eGFR decline and CKD progression at 90 and 365 days.