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. 2023 Dec;10(6):3463-3471.
doi: 10.1002/ehf2.14533. Epub 2023 Sep 15.

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Sumita Barua  1   2   3 , Sean M Conte  1   2   4 , Callum Cherrett  1   2 , Katherine L Kearney  1   2   3   5 , Desiree Robson  1 , Christopher Bragg  1 , Peter S Macdonald  1   2   3 , Kavitha Muthiah  1   2   3 , Christopher S Hayward  1   2   3   6
Affiliations

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Sumita Barua et al. ESC Heart Fail. 2023 Dec.

Abstract

Aims: There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assist devices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectory in VAD supported patients.

Methods and results: We conducted a single-centre retrospective analysis of consecutive VAD implants between 2010 and 2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE was defined as the first event to occur of sustained drop (>50%) in estimated glomerular filtration rate (eGFR), progression to stage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or death on renal replacement therapy at any time. One-hundred and seventy-three patients were included, median age 56.8 years, 18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty-seven patients experienced MAKE. On multivariate analysis, post-implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocytes on blood film analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88, P < 0.001 and adjusted odds ratio 3.33, P = 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80, P < 0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3-month improvement in eGFR, seen in other cohorts.

Conclusions: MAKE significantly impacts survival. In our cohort, MAKE was predicted by post-implant right ventricular failure and chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE.

Keywords: Major adverse kidney events; Survival; Ventricular assist device.

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Conflict of interest statement

The authors have no financial conflicts of interest relevant to this manuscript to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of survival to transplant in VAD supported patients experiencing MAKE. MAKE, major adverse kidney events; VAD, ventricular assist devices.
Figure 2
Figure 2
Kaplan–Meier curves of survival to transplant in VAD supported patients by individual components of major adverse kidney events. (A) Survival to transplant in VAD supported patients with eGFR drop >50%. (B) Survival to transplant in VAD supported patients progressing to stage V CKD. (C) Survival to transplant in VAD supported patients requiring RRT beyond index admission, or death on RRT. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; RRT, renal replacement therapy; VAD, ventricular assist devices.
Figure 3
Figure 3
Linear mixed model point estimates for eGFR at each time point according to survival and MAKE status. eGFR, estimated glomerular filtration rate; MAKE, major adverse kidney events; VAD, ventricular assist devices.
See this image and copyright information in PMC

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