Daimee Usama A, Wang Meng, Papernov Anna, Sherazi Saadia, McNitt Scott, Vidula Himabindu, Chen Leway, Alexis Jeffrey D, Kutyifa Valentina
Heart Research Follow-Up Program and Cardiology Division, University of Rochester Medical Center, Rochester, New York.
Heart Research Follow-Up Program and Cardiology Division, University of Rochester Medical Center, Rochester, New York.
Am J Cardiol. 2017 Dec 15;120(12):2213-2220. doi: 10.1016/j.amjcard.2017.09.004. Epub 2017 Sep 19.
Limited data assessing the clinical significance of post-left ventricular assist device (LVAD) in renal function are available. We aimed to investigate the impact of changes in renal function after LVAD implantation on subsequent long-term outcomes. We followed 184 patients with HeartMate II LVADs implanted between May 2008 and November 2014. Serial assessment of renal function, was performed at baseline and at day 1, day 7, 1 month, 3 months, 6 months, 1 year, and 2 years after implantation. Effects of 1-month GFR and changes in GFR from baseline to 1 month on long-term mortality and hospital re-admission were evaluated. There were 30 patients with GFR <45 (low), 44 with GFR 45 to 59 (intermediate), and 110 with GFR ≥60 (normal) at baseline. Only patients with baseline GFR <45 experienced significant improvement in GFR after 2 years of follow-up (p = 0.012). At 1 month, a higher GFR category was significantly associated with a 31% reduction in mortality (hazard ratio [HR] 0.69, CI 0.49 to 0.98, p = 0.036), but not re-admission. Patients with baseline low and intermediate GFR who had no improvement in renal function category at 1 month experienced significantly greater risk of mortality (HR 1.95, CI 1.10 to 3.43, p = 0.022) and re-admission (HR 1.75, CI 1.07 to 2.84, p = 0.025), relative to patients whose GFR was normal at baseline and 1 month. In conclusion, renal function after LVAD implantation improves in patients with GFR <45. Change in renal function from baseline to 1 month after implantation is a powerful marker of long-term outcomes.
评估左心室辅助装置（LVAD）植入术后对肾功能临床意义的可用数据有限。我们旨在研究LVAD植入术后肾功能变化对后续长期预后的影响。我们对2008年5月至2014年11月期间植入HeartMate II LVAD的184例患者进行了随访。在基线以及植入后第1天、第7天、1个月、3个月、6个月、1年和2年对肾功能进行了系列评估。评估了植入后1个月的肾小球滤过率（GFR）以及从基线到1个月GFR的变化对长期死亡率和再次入院的影响。基线时，有30例患者的GFR<45（低），44例患者的GFR为45至59（中等），110例患者的GFR≥60（正常）。仅基线GFR<45的患者在随访2年后GFR有显著改善（p = 0.012）。在1个月时，较高的GFR类别与死亡率降低31%显著相关（风险比[HR] 0.69，可信区间[CI] 0.49至0.98，p = 0.036），但与再次入院无关。与基线和1个月时GFR正常的患者相比，基线GFR低和中等且在1个月时肾功能类别无改善的患者死亡风险显著更高（HR 1.95，CI 1.10至3.43，p = 0.022），再次入院风险也显著更高（HR 1.75，CI 1.07至2.84，p = 0.025）。总之，LVAD植入术后GFR<45的患者肾功能有所改善。植入后从基线到1个月的肾功能变化是长期预后的有力指标。
