Acute Kidney Injury Predicts Outcomes Following Ventricular Assist Device Insertion

Abstract

<h3>Purpose</h3> Renal function following ventricular assist device (VAD) implantation is a key determinant of survival. The purpose of our study was to investigate whether the development of acute kidney injury (AKI) prior to, or following, VAD implantation influenced survival to transplant. We also sought to determine if the use of extra-corporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) influenced AKI pre or post-VAD. <h3>Methods</h3> We undertook a single-centre retrospective cohort study examining outcomes in patients who underwent VAD implantation between 2010 and 2020. AKI was defined as per the KDIGO guidelines. The primary outcome was survival to transplant. <h3>Results</h3> 61% (96/158) of patients experienced pre-VAD AKI which predicted an increased risk of mortality (OR 2.32, p=0.032, CI 1.07 - 5.04). The incidence of post-VAD AKI was 54% (89/165) which was similarly associated with an increased risk of mortality (OR 2.49, p=0.012, CI 1.21 - 5.13). 67% (64/96) of patients who experienced pre-VAD AKI had post-VAD AKI. Patients who had both pre and post-VAD AKI had a significantly increased mortality prior to transplant with an OR of 3.5 (P=0.01, CI 1.3 - 9.41). Patients with pre-VAD AKI were more likely to require ECMO prior to VAD implantation (OR 2.94) however no difference was observed for IABP use. The use of ECMO or IABP prior to VAD implantation did not influence post-VAD AKI. <h3>Conclusion</h3> Acute kidney injury both pre and post-VAD implantation reduced likelihood of survival to transplant. Patients with AKI prior to VAD insertion were more likely to require ECMO, however the use of ECMO or IABP pre-VAD insertion did not appear to influence post-VAD AKI.