Journal of cardiothoracic and vascular anesthesia · 2026
New Dialysis-Dependent Renal Failure After Durable LVAD Implantation: Risk Factors and Potential Targets for Improvement.
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D'Alonzo Nicholas, Darden Nola, Chand Paras, Schaefer Eric W, Walker Justin W
Аннотация
OBJECTIVES: To identify preoperative predictors of postoperative renal replacement therapy (RRT) in patients undergoing left ventricular assist device (LVAD) implantation to help guide interventions that could decrease the incidence of new dialysis-dependent acute kidney injury (AKI).
DESIGN: Retrospective cohort study.
SETTING: A single-center, university hospital.
PARTICIPANTS: There were 159 adult patients undergoing LVAD implantation between July 2012 to July 2024 INTERVENTIONS: Retrospective analysis of preoperative variables, including hemoglobin, creatinine, MELD score, and intraoperative RBC transfusion volume and their effect on the primary outcome of new dialysis-dependent AKI.
MEASUREMENTS AND MAIN RESULTS: New dialysis-dependent AKI occurred in 17% of patients. Preoperative hemoglobin was inversely associated with RRT risk; every 1-g/dL increase was associated with a 21% reduction in odds ratio (OR 0.79; CI 0.65-0.97, p = .023). Intraoperative red blood cell transfusion volume was a major predictor, with patients receiving 0 to 5 units having significantly lower OR than those receiving ≥11 units (OR 0.01; 95% CI 0.001-0.11; p < .001). MELD scores between 10 and 20 also increased the OR (OR 3.10; 95% CI 1.07-9.00; p = .038). Additionally, needing new dialysis was strongly associated with prolonged mechanical ventilation (OR 8.76; 95% CI 2.52-30.5; p = .001) and postoperative gastrointestinal bleeding (OR 3.73; 95% CI 1.48-9.40; p = .005).
CONCLUSION: Preoperative hemoglobin and perioperative red blood cell transfusion volume are significant and potentially actionable, modifiable risk factors for postoperative RRT in LVAD recipients. Optimizing preoperative hemoglobin may offer a targeted strategy to reduce RRT rates in this high-risk population.
DESIGN: Retrospective cohort study.
SETTING: A single-center, university hospital.
PARTICIPANTS: There were 159 adult patients undergoing LVAD implantation between July 2012 to July 2024 INTERVENTIONS: Retrospective analysis of preoperative variables, including hemoglobin, creatinine, MELD score, and intraoperative RBC transfusion volume and their effect on the primary outcome of new dialysis-dependent AKI.
MEASUREMENTS AND MAIN RESULTS: New dialysis-dependent AKI occurred in 17% of patients. Preoperative hemoglobin was inversely associated with RRT risk; every 1-g/dL increase was associated with a 21% reduction in odds ratio (OR 0.79; CI 0.65-0.97, p = .023). Intraoperative red blood cell transfusion volume was a major predictor, with patients receiving 0 to 5 units having significantly lower OR than those receiving ≥11 units (OR 0.01; 95% CI 0.001-0.11; p < .001). MELD scores between 10 and 20 also increased the OR (OR 3.10; 95% CI 1.07-9.00; p = .038). Additionally, needing new dialysis was strongly associated with prolonged mechanical ventilation (OR 8.76; 95% CI 2.52-30.5; p = .001) and postoperative gastrointestinal bleeding (OR 3.73; 95% CI 1.48-9.40; p = .005).
CONCLUSION: Preoperative hemoglobin and perioperative red blood cell transfusion volume are significant and potentially actionable, modifiable risk factors for postoperative RRT in LVAD recipients. Optimizing preoperative hemoglobin may offer a targeted strategy to reduce RRT rates in this high-risk population.