Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients

Alexandra Idrovo, Seth A. Hollander, Tara M. Neumayr, Cynthia Bell, Genevieve Munoz, Swati Choudhry, Jack Price, Iki Adachi, Poyyapakkam Srivaths, Scott Sutherland, Ayse Akcan-Arikan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Continuous-flow ventricular assist devices (CF-VADs) are used increasingly in pediatric end-stage heart failure (ESHF) patients. Alongside common risk factors like oxidant injury from hemolysis, non-pulsatile flow constitutes a unique circulatory stress on kidneys. Post-implantation recovery after acute kidney injury (AKI) is commonly reported, but long-term kidney outcomes or factors implicated in the evolution of chronic kidney disease (CKD) with prolonged CF-VAD support are unknown. Methods: We studied ESHF patients supported > 90 days on CF-VAD from 2008 to 2018. The primary outcome was CKD (per Kidney Disease Improving Global Outcomes (KDIGO) criteria). Secondary outcomes included AKI incidence post-implantation and CKD evolution in the 6–12 months of CF-VAD support. Results: We enrolled 134 patients; 84/134 (63%) were male, median age was 13 [IQR 9.9, 15.9] years, 72/134 (54%) had preexisting CKD at implantation, and 85/134 (63%) had AKI. At 3 months, of the 91/134 (68%) still on a CF-VAD, 34/91 (37%) never had CKD, 13/91 (14%) developed de novo CKD, while CKD persisted or worsened in 49% (44/91). Etiology of heart failure, extracorporeal membrane oxygenation use, duration of CF-VAD, AKI history, and kidney replacement therapy were not associated with different CKD outcomes. Mortality was higher in those with AKI or preexisting CKD. Conclusions: In the first multicenter study to focus on kidney outcomes for pediatric long-term CF-VAD patients, preimplantation CKD and peri-implantation AKI were common. Both de novo CKD and worsening CKD can happen on prolonged CF-VAD support. Proactive kidney function monitoring and targeted follow-up are important to optimize outcomes. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.]

Original languageEnglish
JournalPediatric Nephrology
DOIs
StateAccepted/In press - 2023

Keywords

  • AKI
  • CKD
  • Continuous-flow VAD
  • End-stage heart failure
  • Kidney outcomes
  • Mechanical circulatory support
  • Ventricular assist device

Fingerprint

Dive into the research topics of 'Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients'. Together they form a unique fingerprint.

Cite this