Liu Hua, Jeng Eric, Demos Daniel, Vilaro Juan, Ahmed Mustafa M, Parker Alex, Pinzon James, Aranda Juan, Beaver Thomas M, Arnaoutakis George J
Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida.
J Card Surg. 2020 Oct;35(10):2529-2538. doi: 10.1111/jocs.14873. Epub 2020 Aug 2.
Renal function may improve after left ventricular assist device (LVAD) implant, however, some patients develop postoperative acute kidney injury (AKI). Randomized trials showed benefit for early renal replacement therapy (RRT) in critically ill patients with AKI, but this practice has not been studied in LVAD patients.
We performed a single-center, retrospective cohort study of all adults (>18 years) who underwent LVAD placement from 1/2010 to 12/2018. We collected preoperative, hemodynamic, echocardiographic, intraoperative, and postoperative data. AKI was defined according to Kidney Disease: Improving Global Outcomes definition. Early (E) RRT was considered treatment at AKI stage II or below. Standard (S) RRT was considered treatment at AKI stage III. Outcomes and Kaplan-Meier analysis were compared between groups.
A total of 184 patients were included (mean age 56.10 years, 81% males, 30.4% African-American race). A total of 71 (38.6%) developed AKI and 17 (9.24%) needed RRT (11 E vs 6 S). A total of 11 remained hemodialysis-dependent at discharge (5 [45.5%] in E vs 6 [100%] in S, P = .043). There was a trend toward shorter intensive care unit stay and ventilation time in E group, and overall hospital stay was significantly less in the E group (48.18 ± 25.95 vs 94.00 ± 53.07 days, P = .028). Thirty-day mortality was similar between groups (E 18% vs S 16%, P = .9), but there was a trend toward improved overall survival in the E group.
This is the first study to examine early initiation of RRT after LVAD implant. Early RRT was associated with shorter hospital stay, lower need for permanent RRT, and a trend toward improved survival. This practice may provide significant cost savings and should be examined further.
左心室辅助装置（LVAD）植入后肾功能可能改善，然而，部分患者术后会发生急性肾损伤（AKI）。随机试验表明，早期肾脏替代治疗（RRT）对重症AKI患者有益，但LVAD患者尚未开展此项研究。
我们对2010年1月至2018年12月期间接受LVAD植入的所有成人（>18岁）进行了一项单中心回顾性队列研究。我们收集了术前、血流动力学、超声心动图、术中及术后数据。AKI根据《改善全球肾脏病预后组织》定义。早期（E）RRT被视为AKI II期及以下的治疗。标准（S）RRT被视为AKI III期的治疗。比较两组的结局和Kaplan-Meier分析。
共纳入184例患者（平均年龄56.10岁，81%为男性，30.4%为非裔美国人）。共71例（38.6%）发生AKI，17例（9.24%）需要RRT（11例E组 vs 6例S组）。出院时共有11例仍依赖血液透析（E组5例[45.5%] vs S组6例[100%]，P = 0.043）。E组重症监护病房住院时间和通气时间有缩短趋势，E组总体住院时间显著缩短（48.18±25.95天 vs 94.00±53.07天，P = 0.028）。两组30天死亡率相似（E组18% vs S组16%，P = 0.9），但E组总体生存率有改善趋势。
这是第一项研究LVAD植入后早期启动RRT的研究。早期RRT与缩短住院时间、降低永久性RRT需求及生存率改善趋势相关。这种做法可能显著节省成本，应进一步研究。
