Early Renal Recovery after Left Ventricular Assist Device Implantation is Associated with Improved Clinical Outcomes in Patients with Kidney Disease at Baseline

Abstract

Purpose Advanced renal dysfunction is often viewed as a relative contraindication to durable left ventricular assist device (LVAD) implantation. We investigated the impact of early renal recovery on clinical outcomes after LVAD implantation. Methods All patients with baseline renal dysfunction who were implanted with a durable LVAD between September 2007 and September 2017 from a single institution were studied. Glomerular filtration rates at time of LVAD implant, 1 week, 1 month and 6 months after implant were collected. Early renal improvement was defined as an increase in eGFR of ≥ 15% within 1 week of implant (ΔGFR≥15%). Outcomes collected included index hospitalization length of stay (LOS), LVAD-related complications, hospitalizations and death. Results 405 patients were implanted with durable LVADs, of which, 191 patients (average age 59 years, 80% male, 73% African American, 46% bridge to transplant, 59% centrifugal) had varying degrees of renal dysfunction at implantation (17% CKD 1 or 2, 35% CKD 3a, 33% CKD 3b and 15% CKD 4 or 5). 68% of patients experienced ΔGFR≥15%. African American ethnicity and obesity (BMI 31.6 ± 6.9 vs. 28.7 ± 6.9, p =0.01) was associated with less renal improvement compared with their counterparts. Patients with ΔGFR≥15% were more likely to be CKD stage 1 or 2 six months after LVAD implant (53% vs. 22%, p\u202f=\u202f0.005) (figure top). Index hospitalization LOS (39 ± 21 vs. 50 ± 32 days, p =0.02) was lower in patients with ΔGFR≥15% with fewer percutaneous endoscopic gastrostomy tube placement (4% vs. 15%, p\u202f=\u202f0.02) and tracheostomy (6% vs 13%, p\u202f=\u202f0.14). Patients with ΔGFR≥15% also had fewer heart failure readmissions (12% vs. 24%, p Conclusion Early improvement in renal function is associated with sustained renal recovery, decreased length of stay, fewer complications at index hospitalization and reduced heart failure readmissions.