Durable continuous-flow LVAD implantation was associated with relatively stable eGFR over 2 years, though men and women exhibited significantly different eGFR trajectories (interaction P=0.005).
Observational (n=288)
No
Does durable continuous-flow LVAD implantation affect long-term estimated glomerular filtration rate trajectories in adults with advanced heart failure?
Following LVAD implantation, eGFR remains relatively stable over 2 years, though distinct sex-based trajectories exist with men experiencing an early decline and women an early increase.
p-value: p=0.005
Background Advanced kidney disease is often a relative contraindication to left ventricular assist device (LVAD) implantation because of concerns for poor outcomes including worsening kidney disease. Data are lacking on long‐term changes and sex‐based differences in estimated glomerular filtration rate (eGFR), with published data limited by potential bias introduced by the competing risks of death and heart transplantation. Methods and Results We conducted a longitudinal analysis of 288 adults receiving durable continuous‐flow LVADs from January 2010 to December 2017 at a single center. A joint model was constructed to evaluate change in eGFR over 2 years, the prespecified primary outcome, adjusted for the competing risks of death and heart transplantation. Median baseline eGFR was 60 mL/min per 1.73 m 2 (interquartile range 42–78). At 2 years, 74 patients died and 104 received a heart transplant. In unadjusted analysis, LVAD recipients had a modest initial increase in eGFR of ≈2 mL/min per 1.73 m 2 within the first 6 months after implantation, followed by a decrease in eGFR below baseline values at 1 and 2 years. Men experienced an eGFR decline of 5 to 10 mL/min per 1.73 m 2 over the first year which then stabilized, while women had an ≈5 mL/min per 1.73 m 2 increase in eGFR within the first 6 months followed by decline towards baseline eGFR levels (interaction P =0.005). Conclusions Estimated GFR remains relatively stable in most patients following LVAD implantation. Larger studies are needed to investigate sex‐based differences in eGFR and to evaluate eGFR trajectory and mortality in LVAD recipients with lower eGFR.
Roehm et al. (Fri,) conducted a observational in Advanced heart failure requiring LVAD (n=288). Durable continuous-flow LVAD was evaluated on Change in eGFR over 2 years, adjusted for the competing risks of death and heart transplantation (p=0.005). Durable continuous-flow LVAD implantation was associated with relatively stable eGFR over 2 years, though men and women exhibited significantly different eGFR trajectories (interaction P=0.005).