Impact of Renal Injury on Survival Following Left Ventricular Assist Device

Abstract

Introduction Left ventricular assist devices (LVAD) are increasingly used in end-stage heart failure treatment. In this group of patient, the risk of acute renal injury (ARI) after LVAD is high. Kidney Disease Improving Global Outcomes (KDIGO) is a common consensus used throughout the world for the care and maintenance of kidney function. In this study, we aimed to investigate the effects of ARI and dialysis requirement on mortality using KDIGO criteria in the early period after LVAD implantation. Materials and Methods 62 patients who underwent VAD implantation between April 2012 and October 2017 were evaluated retrospectively. The preoperative and postoperative renal functions of the patients were evaluated and classified according to the criteria of KDIGO (Table 1). Patients who developed ARI and dialysis needs and the mortality of these patients were evaluated. Results 12 patients died in all groups. ABI was detected in 27 patients in the early period. Of these patients, 17 received continuous renal replacement therapy (CRRT). Early mortality developed in 10 (37%) of the ABI-developing patients and 9 of the CRRT-treated patients (52.9%). Discussion ARI is a common condition in patients with end-stage heart failure and is associated with poor outcome in the postimplant period. The risk of developing a post-implantation ABI ranges from 7% to 56%. CRRT treatment is required in 14% to 32.5% of patients with ABI. ARI development is associated with increased mortality and morbidity. We reached the conclusion that mortality was elevated in ARI patients using KDIGO criteria and almost all patients who needed CRRT died. Conclusion Both congestive heart failure and early ARI following LVAD implantation increase mortality and morbidity significantly.