Prevalence and Prognostic Importance of Changes in Renal Function After Mechanical Circulatory Support

Author:

Brisco Meredith A.1,Kimmel Stephen E.1,Coca Steven G.1,Putt Mary E.1,Jessup Mariell1,Tang Wilson W.H.1,Parikh Chirag R.1,Testani Jeffrey M.1

Affiliation:

1. From the Department of Medicine, Cardiology Division, Medical University of South Carolina, Charleston (M.A.B.); Department of Medicine, Cardiovascular Division (S.E.K., M.J.), and Department of Biostatistics and Epidemiology (S.E.K., M.E.P.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Internal Medicine, and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (S.G.C., C.R.P., J.M.T.); and Department of...

Abstract

Background— The long-term durability and prognostic significance of improvement in renal function after mechanical circulatory support (MCS) has yet to be characterized in a large multicenter population. The primary goals of this analysis were to describe serial post-MCS changes in estimated glomerular filtration rate (eGFR) and determine their association with all-cause mortality. Methods and Results— Adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with serial creatinine levels available (n=3363) were studied. Early post-MCS, eGFR improved substantially (median improvement, 48.9%; P <0.001) with 22.3% of the population improving their eGFR by ≥100% within the first few weeks. However, in the majority of patients, this improvement was transient, and by 1 year, eGFR was only 6.7% above the pre-MCS value ( P <0.001). This pattern of early improvement followed by deterioration in eGFR was observed with both pulsatile and continuous-flow devices. Interestingly, poor survival was associated with both marked improvement (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.19–2.26; P =0.002) and worsening in eGFR (adjusted HR, 1.63; 95% CI, 1.15–2.13; P =0.004). Conclusions— Post-MCS, early improvement in renal function is common but seems to be largely transient and not necessarily indicative of an improved prognosis. This pattern was observed with both pulsatile and continuous-flow devices. Additional research is necessary to better understand the mechanistic basis for these complex post-MCS changes in renal function and their associated survival disadvantage. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00119834.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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