title: Early Gains in Renal Function Following Implantation of HeartMate II Left Ventricular Assist Devices May Not Persist to One Year.
abstract: Renal function improves early after left ventricular assist device (LVAD) implantation but later decline has been observed. We sought to determine the occurrence and evaluate possible causes for this decline. In 62 consecutive patients with HeartMateII LVAD with available calculated glomerular filtration rate (GFR, ml/min/1.73 m) 1 year after implant, GFR was assessed repeatedly and possible predictors for decline from 3 to 12 months were investigated. Post-mortem renal specimens for patients supported with an LVAD were evaluated. GFR 54.5 ± 19.5 at admission increased to 66.4 ± 22.3 preoperatively and to 79.2 ± 30.1 ~1 month after implantation. Subsequently at ~3 months GFR declined to 74.7 ± 25.4, at ~6 months to 68.8 ± 23.1, and ~1 year after implant to 63.9 ± 17.7. Glomerular filtration rate at 1 year was significantly lower (p < 0.0001, p < 0.0001, p = 0.005) than GFR 1, 3, and 6 months after implant. Early rise in GFR after surgery was not associated with late decline. Shorter bypass time (β = -0.09, p = 0.048) and higher albumin 3 months after LVAD (β = 14.4, p = 0.025) were significantly associated with less later decline in GFR. Arteriosclerosis was identified in autopsy renal specimens. In conclusion, early gains in renal function after LVAD implant are not sustained in many patients. Patient, device, and operative factors may influence long-term renal function in these patients.
authors.affiliation: *Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; †Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota; ‡Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota; §Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; and ¶Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tal
authors.initials: T
authors.lastname: Hasin
authors.forename: Avishay
authors.initials: A
authors.lastname: Grupper
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Lyle
authors.initials: L
authors.lastname: Joyce
authors.forename: Richard
authors.initials: R
authors.lastname: Daly
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies