Renal Failure (Jan 2020)

Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis

  • Charat Thongprayoon,
  • Ploypin Lertjitbanjong,
  • Wisit Cheungpasitporn,
  • Panupong Hansrivijit,
  • Tibor Fülöp,
  • Karthik Kovvuru,
  • Swetha R. Kanduri,
  • Paul W. Davis,
  • Saraschandra Vallabhajosyula,
  • Tarun Bathini,
  • Kanramon Watthanasuntorn,
  • Narut Prasitlumkum,
  • Ronpichai Chokesuwattanaskul,
  • Supawat Ratanapo,
  • Michael A. Mao,
  • Kianoush Kashani

DOI
https://doi.org/10.1080/0886022X.2020.1768116
Journal volume & issue
Vol. 42, no. 1
pp. 495 – 512

Abstract

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Background We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD). Methods A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird. Results Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%–30.4%) but rose to 36.9% (95%CI: 31.1%–43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%–15.0%). AKI incidence did not differ significantly between types of LVAD (p = .35) or indication for LVAD use (p = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (p = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = −0.068, p < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00–6.70) and 2.22 (95% CI, 1.62–3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58–12.33) and 5.41 (95% CI, 3.63–8.06), respectively. Conclusion We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.

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