Poor baseline kidney function (eGFR < 45 ml/min/1.73 m²) at VAD implantation was associated with an increased risk of mortality (e.g., HR 3.32; 95% CI 1.10-9.98; p=0.03 for stage 3b CKD).
Observational
Does baseline kidney function and its improvement after VAD implantation predict thromboembolism, hemorrhage, and mortality in heart failure patients?
Poor baseline kidney function at VAD implantation is associated with increased mortality, though post-implant kidney function improvement is not associated with a lower risk of death.
Hazard Ratio: 3.32 (95% CI 1.1–9.98)
p-value: p=0.03
Although heart transplantation remains the gold standard for management of heart failure, ventricular assist devices (VAD) have emerged as viable alternatives. VAD implantation improves kidney function. However, whether the improvement is sustained or associated with improved outcomes is unclear. Herein we assess kidney function improvement, predictors of improvement, and associations with thromboembolism, hemorrhage, and mortality in VAD patients. Kidney function was defined using chronic kidney disease (CKD) stages: stage 1 (glomerular filtration rate eGFR ≥ 90 ml/min/1.73 m), stage 2 (eGFR 60-90 ml/min/1.73 m), stage 3a (eGFR 45-59 ml/min/1.73 m), stage 3b (eGFR 30-44 ml/min/1.73 m), stage 4 (eGFR 15-30 ml/min/1.73 m), and stage 5 (eGFR 45 ml/min/1.73 m; patients with eGFR < 45 ml/min/1.73 m had a higher mortality risk (HR 3.32, 95% CI: 1.10-9.98, p = 0.03 for stage 3b; HR 4.07, 95% CI: 1.27-13.1, p = 0.02 for stage 4; and HR 4.01, 95% CI: 1.17-13.7, p = 0.03 for stage 5 CKD). Kidney function was not associated with thromboembolism or hemorrhage, and sustained improvement was not associated with lower risk of death. However, poor kidney function at implantation was associated with an increased risk of mortality.
Davis et al. (Wed,) conducted a observational in Heart failure requiring ventricular assist device (VAD). Poor baseline kidney function (eGFR < 45 ml/min/1.73 m²) vs. Baseline eGFR > 45 ml/min/1.73 m² was evaluated on Mortality (for stage 3b CKD vs eGFR > 45 ml/min/1.73 m²) (HR 3.32, 95% CI 1.10-9.98, p=0.03). Poor baseline kidney function (eGFR < 45 ml/min/1.73 m²) at VAD implantation was associated with an increased risk of mortality (e.g., HR 3.32; 95% CI 1.10-9.98; p=0.03 for stage 3b CKD).