Predictors of acute renal dysfunction after ventricular assist device placement.

BACKGROUND

Acute renal dysfunction (ARD) is a frequent complication after ventricular assist device (VAD) implantation. The purpose was to identify predictors associated with ARD after VAD implantation.

METHODS AND

RESULTS

ARD was defined using the risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, end-stage kidney disease (RIFLE) criteria. Patients who developed ARD during VAD support (ARD, n=24) were compared with patients who did not (NoARD, n=29). Patients with ARD before implant were excluded. Patient characteristics pre-VAD implant, incidence of complications during support and survival were analyzed. Baseline characteristics were similar. The ARD group had longer cardiopulmonary bypass (CPB) time, greater need for reoperation and higher risk of bleeding (>1 L) intraoperatively (P < .05). The ARD group had a higher incidence of infections (17% vs. 50%, OR 5, 95%CI 1.3-17), liver injury (58% vs. 17%, OR 7, 95%CI 2-24), ventricular arrhythmias (42% vs. 14%, OR 4, 95%CI 1.1-16), and right ventricular failure (73% vs. 30%, OR 7, 95%CI 2-24). Need for dialysis was associated with higher pre-VAD creatinine and worse outcomes. Survival was significantly lower in the ARD group (HR 8.5, 95%CI 2-29).

CONCLUSIONS

Acute renal dysfunction is a common and serious complication post-VAD implantation and is associated with reduced survival. Longer CPB time, higher intraoperative blood loss, and reoperation are associated factors with the development of this disease.