Lim Oliver, Anbalakan Kamalesh, Ruiyang Ling Ryan, Tan Bryan, Mak Vivien, Chen Ying, Kaushik Manish, Chakaramakkil Matthew Jose, Ramanathan Kollengode
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Cardiology, National Heart Centre Singapore, Singapore General Hospital, Singapore, Singapore,
Blood Purif. 2025 Jun 18:1-16. doi: 10.1159/000546854.
The use of temporary-left ventricular assist devices (T-LVADs) for circulatory support in cardiogenic shock is increasing along with complications like acute kidney injury requiring kidney replacement therapy (KRT). While KRT is linked to mortality in cardiogenic shock, data on mortality in patients receiving both T-LVAD and KRT are limited.
We conducted a systematic review and meta-analysis, searching three databases from inception through December 30, 2023, for studies reporting on patients with concurrent T-LVAD and KRT support during cardiogenic shock. We performed random-effects meta-analyses, looking at in-hospital mortality as our primary outcome. Subgroup analysis was performed based on the continent, timing of KRT, and type of T-LVAD. Risk of bias was assessed with the Joanna Briggs Institute checklists and certainty of evidence with the GRADE approach.
We included 35 studies after screening through 89 full-text articles, consisting of 2,277 individuals receiving T-LVAD and 722 (30.9%, 95% CI: 25.8-36.6) receiving concurrent KRT. In-hospital mortality was pooled across 6 studies, with 91 non-survivors (65.5%) among 139 individuals (95% CI: 57.2-72.9). Concurrent KRT and T-LVAD was associated with higher in-hospital (OR 3.48, 95% CI: 2.20-5.49) and overall mortality (OR 2.19, 95% CI: 1.01-4.76) compared to patients not on KRT. The proportion of patients on KRT was significantly (p interaction = 0.0004) larger in Europe (37.2%, 95% CI: 32.2-42.4) than North America (18.2%, 95% CI: 12.0-26.7). Region, type of T-LVAD, and publication year did not significantly impact any of the mortality outcomes.
Patients on concurrent KRT and T-LVAD suffer significantly greater odds of mortality compared to patients not receiving KRT during their hospital admission. A substantial proportion of patients receiving T-LVADs require KRT. Further studies with head-to-head comparisons between KRT and non-KRT treatment arms are warranted to confirm our findings, in addition to identifying at-risk populations that require KRT and potential interventions to improve survival in this subset of patients.
用于心源性休克循环支持的临时左心室辅助装置（T-LVAD）的使用正在增加，同时诸如需要肾脏替代治疗（KRT）的急性肾损伤等并发症也在增加。虽然KRT与心源性休克的死亡率相关，但关于接受T-LVAD和KRT治疗的患者死亡率的数据有限。
我们进行了一项系统评价和荟萃分析，检索了三个数据库，从数据库建立到2023年12月30日，查找关于心源性休克期间同时接受T-LVAD和KRT支持的患者的研究报告。我们进行了随机效应荟萃分析，将住院死亡率作为主要结局。基于大洲、KRT的时机和T-LVAD的类型进行亚组分析。使用乔安娜·布里格斯研究所清单评估偏倚风险，使用GRADE方法评估证据的确定性。
在筛选了89篇全文文章后，我们纳入了35项研究，其中包括2277名接受T-LVAD治疗的个体和722名（30.9%，95%CI：25.8 - 36.6）同时接受KRT治疗的个体。对6项研究的住院死亡率进行了汇总，139名个体中有91名非幸存者（65.5%）（95%CI：57.2 - 72.9）。与未接受KRT治疗的患者相比，同时接受KRT和T-LVAD治疗与更高的住院死亡率（OR 3.48，95%CI：2.20 - 5.49）和总体死亡率（OR 2.19，95%CI：1.01 - 4.76）相关。欧洲接受KRT治疗的患者比例（37.2%，95%CI：32.2 - 42.4）显著高于北美（18.2%，95%CI：12.0 - 26.7）（p交互作用 = 0.0004）。地区、T-LVAD的类型和发表年份对任何死亡率结局均无显著影响。
与住院期间未接受KRT治疗的患者相比，同时接受KRT和T-LVAD治疗的患者死亡几率显著更高。接受T-LVAD治疗的患者中有很大一部分需要KRT。除了识别需要KRT的高危人群以及可能改善该亚组患者生存率的潜在干预措施外，还需要进行KRT治疗组与非KRT治疗组直接比较的进一步研究来证实我们的发现。
