title: Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.
abstract: Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation.
  
  
  
  Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (<40 mL/min/1.73 m2) and proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank P<0.001).
  
  
  
  Estimated glomerular filtration rate and proteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making.
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY. vt2113@cumc.columbia.edu.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Ellie J
authors.initials: EJ
authors.lastname: Coromilas
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Arthur Reshad
authors.initials: AR
authors.lastname: Garan
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Li
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castagna
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jennings
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sladen
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
authors.affiliation: From the Division of Cardiology (V.K.T., E.C., A.R.G., R.C.L., F.C., D.J., M.Y., D.M.M., P.C.C.) and Division of Nephrology (J.R.), Department of Medicine, Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), and Division of Critical Care, Department of Anesthesiology (R.N.S.), Columbia University Medical Center - New York Presbyterian, NY.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011507:Proteinuria / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012372:ROC Curve; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acute kidney injury; algorithms; biomarker; blood urea nitrogen; renal insufficiency