Acute kidney injury early after left ventricular assist device implantation: incidence, risk factors and clinical consequences

E. Gündüz

Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey. dregunduz@hotmail.com

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• Anesthesiology
• Hepatology

OBJECTIVE: Renal dysfunction or renal failure is a common complication in patients undergoing a left ventricular assist device (LVAD). Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) is the most commonly used inexpensive and easy method for the evaluation of kidney function. In studies, the development of acute kidney injury (AKI) after LVAD has generally been studied at 1, 3 months and 1 year, but there are almost no studies with 1-week data.

PATIENTS AND METHODS: We retrospectively analyzed the incidence of AKI, risk factors, length of stay in hospital and intensive care unit (ICU), and postoperative complications of 138 patients who underwent LVAD implantation in our center between 2012 and 2021, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the preoperative, postoperative 1st day, 2nd day, 1st week, 1st month, 3rd month and 1st year serum creatinine, eGFR and blood urea nitrogen (BUN) values.

RESULTS: The mean age of 138 patients who underwent LVAD implantation and evaluated the development of AKI was 50.4 (±10.86) and 119 (86.2%) were males. The incidence of AKI, the need for renal replacement therapy (RRT) and dialysis after LVAD implant were respectively 25.4%, 25.3% and 12.3%. According to the KDIGO criteria, in the AKI (+) patient group, 21 (15.2%) cases were identified as stage 1, 9 (6.5%) as stage 2 and 5 (3.6%) as stage 3. The incidence of AKI was found to be high in cases with diabetes mellitus (DM), age, preoperative creatinine level ≥1.2, and eGFR ≤60 ml/min/m2. There is a statistically significant relationship between having AKI and right ventricular (RV) failure (p=0.0033). Right ventricular failure developed in 10 (28.6%) of 35 patients who developed AKI.

CONCLUSIONS: If perioperative AKI is recognized early, the development of advanced stages of AKI and mortality can be reduced with nephroprotective measures.

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