Abstract 9367: Predictors of Renal Function Improvement After Left Ventricular Assist Device Implantation in Moderate to Severe Chronic Kidney Disease

Abstract

Introduction: Renal dysfunction remains a relative contraindication to left ventricular assist device (LVAD) implantation due to postoperative morbidity and mortality in advanced stages of chronic kidney disease (CKD). However, correlates of early improvement and long-term durability of renal function have not been well elucidated in this population. Methods: We evaluated 113 consecutive patients who underwent LVAD implantation in our center from 2008 - 2019. Patients with pre-LVAD glomerular filtration rate (GFR) < 60 mL/min (defined as the highest GFR reported within 30 days prior to implantation) were included. Demographic, clinical, echocardiographic, and hemodynamic data were collected during the index admission and up to two years after implantation. Results: Seventy-two patients met inclusion criteria (mean age 61 ± 12 years, male 88%, white 39%, nonischemic cardiomyopathy 60%, hypertension 61%, diabetes 47%, destination therapy 72%, HeartMate [HM] II 76%, HM3 24%). Forty-three patients (60%) had an increase and 26 (36%) had a >25% improvement in GFR 3 months after implantation. The absence of proteinuria, defined as >150 mg/day per a spot urine protein:creatinine ratio, was associated with >25% improvement in GFR 3 months postoperatively (OR 3.85, 95% CI 1.24- 12.0, p = 0.02). No history of coronary artery disease, higher pre-implant albumin and hemoglobin levels, and shorter intra-operative bypass times were also associated with >25% improvement in renal function at 3 months (all p <0.05). Average GFR improved one month after LVAD implantation and remained stably improved for up to two years in patients with moderate to severe CKD (Figure). Conclusion: Early improvement in renal function appears to be durable for at least two years after LVAD implantation in patients with moderate to severe CKD. The absence of proteinuria, potentially reflecting a lack of intrinsic renal disease, may predict early improvement in renal function after LVAD implantation.