Distinctive Kidney Function Trajectories Following Left Ventricular Assist Device Implantation

Authors

Carl P Walther
Julia S Benoit
Harveen K Lamba
Andrew B Civitello
Kevin F Erickson
Nandan K Mondal
Kenneth K Liao
Sankar D Navaneethan

Publication Date

12-1-2022

Journal

The Journal of Heart and Lung Transplantation

DOI

10.1016/j.healun.2022.08.024

PMID

36182652

PMCID

PMC10091513

PubMedCentral® Posted Date

10-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Adult, Humans, Heart-Assist Devices, Heart Failure, Treatment Outcome, Heart Transplantation, Registries, Kidney, Retrospective Studies, continuous-flow left ventricular assist device, advanced heart failure, trajectory, kidney function, cardiorenal, latent class mixed models

Abstract

BACKGROUND: The aim of this study was to assess for distinct kidney function trajectories following left ventricular assist device (LVAD) placement. Cohort studies of LVAD recipients demonstrate that kidney function tends to increase early after LVAD placement, followed by decline and limited sustained improvement. Inter-individual differences in kidney function response may be obscured.

METHODS: We identified continuous flow LVAD implantations in US adults (2016-2017) from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Primary outcomes were estimated glomerular filtration rate (eGFR) trajectories pre-implantation to ∼12 months. Latent class mixed models were applied to primary and validation samples. Clinical differences among trajectory groups were investigated.

RESULTS: Among 4,615 LVAD implantations, 5 eGFR trajectory groups were identified. The 2 largest groups (Groups 1 and 2) made up >80% of the cohort, and were similar to group average trajectories previously reported, with early eGFR rise followed by decline and stabilization. Three novel trajectory groups were found: worsening followed by sustained low kidney function (Group 3, 10.1%), sustained improvement (Group 4, 3.3%), and worsening followed by variation (Group 5, 1.7%). These groups differed in baseline characteristics and outcomes. Group 4 was younger and had more cardiogenic shock and pre-implantation dialysis; Group 3 had higher rates of pre-existing chronic kidney disease, along with older age.

CONCLUSIONS: Novel eGFR trajectories were identified in a national cohort, possibly representing distinct cardiorenal processes. Type 1 cardiorenal syndrome may have been predominant in Group 4, and parenchymal kidney disease may have been predominant in Group 3.

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