Novel Estimates of Renal Function are Associated with Short-Term Left Ventricular Assist Device Outcomes

• Published in: The Journal of surgical research Vol. 283; pp. 217 - 223
• Main Authors: George, Timothy J., Biedermann, Scott, DiMaio, J. Michael, Kabra, Nitin, Rawitscher, David A., Afzal, Aasim
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Estimated glomerular filtration; Female; Glomerular Filtration Rate; Heart-Assist Devices; Humans; Kidney - physiology; Kidney function; Left ventricular assist device; Male; Race; Renal function; Renal Insufficiency, Chronic - epidemiology; Retrospective Studies; Left ventricular assist device; Renal function; Estimated glomerular filtration; Kidney function; Race
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.10.072

Although preoperative kidney function has been associated with left ventricular assist device (LVAD) outcomes, most previous estimates of glomerular filtration rates (eGFRs) have utilized race in the calculation. Recently, novel eGFR equations independent of race have been suggested and validated. Therefore, we undertook this study to evaluate the predictive value of a novel, non–race-based eGFR calculation on short-term LVAD outcomes. We conducted a retrospective review of all primary LVAD implants from 2017 to 2022 at our institution. eGFR was calculated using the novel Chronic Kidney Disease Epidemiology Collaboration 2021 formula (CKD-EPI 2021). eGFR was also calculated according to the Modification of Diet in Renal Disease equation for historical reference. Primary stratification was by eGFR: ≥60, 30-60, and <30. The primary outcome was 1-y survival. Multivariable Cox proportional hazards regression modeling was used to further evaluate the impact of kidney function on 1-y mortality. From 2017 to 2022, 91 patients underwent LVAD implantation with a HeartMate 3 device. The average age was 65.20 ± 11.08, 77 (84.62%) were male, and 14 (15.38%) were Black. The mean CKD-EPI 2021 eGFR was 56.07 ± 23.55 compared with 54.72 ± 26.37 as calculated by Modification of Diet in Renal Disease (P = 0.719). Overall, 30-d and 1-y survival was 96.7% and 85.0%, respectively. When stratified by eGFR, there was a significant difference in 1-y survival (≥60, 93.46%; 30-60, 87.36%; <30, 62.75%; P = 0.016). On multivariable analysis, a preoperative eGFR <30 was associated with an increased hazard of 1-y mortality (5.58 [1.06-29.17], P = 0.043). In conclusion, non–race-based estimates of renal function are predictive of short-term LVAD outcomes. Further investigation of this phenomenon is warranted.