Prevalence and prognostic importance of changes in renal function after mechanical circulatory support.
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.


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.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00119834.
Department of Medicine, Cardiology Division, Medical University of South Carolina, Charleston.
Meredith A
MA
Brisco
Stephen E
SE
Kimmel
Steven G
SG
Coca
Mary E
ME
Putt
Mariell
M
Jessup
Wilson W H
WW
Tang
Chirag R
CR
Parikh
Jeffrey M
JM
Testani
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
cardio-renal syndrome; heart failure; heart-assist devices; transplantation