Serial changes in renal function as a prognostic indicator in advanced heart failure patients with left ventricular assist system

Yoshio Iwashima, Masanobu Yanase, Takeshi Horio, Osamu Seguchi, Yoshihiro Murata, Tomoyuki Fujita, Koichi Toda, Yuhei Kawano, Takeshi Nakatani

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19 Citations (Scopus)

Abstract

Background: Left ventricular assist system (LVAS) implantation is an established treatment for patients with advanced heart failure. We investigated the clinical implication of serial changes in renal function after LVAS implantation. Methods: This study included 110 patients who underwent pulsatile LVAS implantation intended as a bridge to transplantation and were alive more than 2 weeks after implantation. Data collection of demographic and hematologic values was performed 1 day before (baseline) and 2 weeks after implantation. All patients were monitored for 2 years or until death. Results: The 2-year postimplantation mortality rate was 31.8%. Multivariate Cox regression analysis showed the baseline estimated glomerular filtration rate (eGFR) was an independent predictor of death (hazard ratio, 0.90 for each 10 mL/min increase, p < 0.05). The eGFR significantly increased at 2 weeks after LVAS implantation (70.5 ± 37.8 to 121.0 ± 78.8 mL/min, p < 0.01). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the group with an inframedian value of change in eGFR at 2 weeks after implantation (ΔeGFR; p = 0.03) as well as in the group with the lowest tertile of eGFR at 2 weeks after implantation (2w-eGFR; p < 0.01). Multivariate Cox regression analysis showed that ΔeGFR (hazard ratio, 0.89 for each 10 mL/min increase) and 2w-eGFR (hazard ratio, 0.92 for each 10 mL/min increase) were independent predictors of death (p < 0.01, respectively). Conclusions: Impaired renal function, and in particular, a poor response of eGFR to LVAS implantation, may have a strong association with worse outcome.

Original languageEnglish
Pages (from-to)816-823
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number3
DOIs
Publication statusPublished - 03-2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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