持续血流左心室辅助装置治疗对慢性肾脏病的影响：一项纵向多中心研究。
Impact of Continuous Flow Left Ventricular Assist Device Therapy on Chronic Kidney Disease: A Longitudinal Multicenter Study.
机构信息
Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands.
出版信息
J Card Fail. 2020 Apr;26(4):333-341. doi: 10.1016/j.cardfail.2020.01.010. Epub 2020 Jan 23.
BACKGROUND
Many patients undergoing durable left ventricular assist device (LVAD) implantation suffer from chronic kidney disease (CKD). Therefore, we investigated the effect of LVAD support on CKD.
METHODS
A retrospective multicenter cohort study, including all patients undergoing LVAD (HeartMate II (n = 330), HeartMate 3 (n = 22) and HeartWare (n = 48) implantation. In total, 227 (56.8%) patients were implanted as bridge-to-transplantation; 154 (38.5%) as destination therapy; and 19 (4.7%) as bridge-to-decision. Serum creatinine measurements were collected over a 2-year follow-up period. Patients were stratified based on CKD stage.
RESULTS
Overall, 400 patients (mean age 53 ± 14 years, 75% male) were included: 186 (46.5%) patients had CKD stage 1 or 2; 93 (23.3%) had CKD stage 3a; 82 (20.5%) had CKD stage 3b; and 39 (9.8%) had CKD stage 4 or 5 prior to LVAD implantation. During a median follow-up of 179 days (IQR 28-627), 32,629 creatinine measurements were available. Improvement of kidney function was noticed in every preoperative CKD-stage group. Following this improvement, estimated glomerular filtration rates regressed to baseline values for all CKD stages. Patients showing early renal function improvement were younger and in worse preoperative condition. Moreover, survival rates were higher in patients showing early improvement (69% vs 56%, log-rank P = 0 .013).
CONCLUSIONS
Renal function following LVAD implantation is characterized by improvement, steady state and subsequent deterioration. Patients who showed early renal function improvement were in worse preoperative condition, however, and had higher survival rates at 2 years of follow-up.
背景
许多接受耐用性左心室辅助装置（LVAD）植入的患者患有慢性肾脏病（CKD）。因此，我们研究了 LVAD 支持对 CKD 的影响。
方法
这是一项回顾性多中心队列研究，纳入所有接受 LVAD（HeartMate II（n=330）、HeartMate 3（n=22）和 HeartWare（n=48）植入的患者。共有 227 例（56.8%）患者作为移植桥接植入；154 例（38.5%）作为终末期治疗；19 例（4.7%）作为决策桥接。在 2 年的随访期间收集血清肌酐测量值。根据 CKD 分期对患者进行分层。
结果
共纳入 400 例患者（平均年龄 53±14 岁，75%为男性）：186 例（46.5%）患者 CKD 分期 1 或 2 期；93 例（23.3%）患者 CKD 分期 3a 期；82 例（20.5%）患者 CKD 分期 3b 期；39 例（9.8%）患者在植入 LVAD 前 CKD 分期 4 或 5 期。在中位随访 179 天（IQR 28-627）期间，可获得 32629 次肌酐测量值。在每个术前 CKD 分期组中均观察到肾功能改善。在这种改善之后，所有 CKD 分期的估计肾小球滤过率都回归到基线值。早期肾功能改善的患者更年轻，术前情况更差。此外，早期改善的患者生存率更高（69%比 56%，log-rank P=0.013）。
结论
LVAD 植入后肾功能的特点是改善、稳定和随后的恶化。然而，早期肾功能改善的患者术前情况更差，但在 2 年随访时生存率更高。
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