Prevalence and prognostic importance of changes in renal function after mechanical circulatory support.
BACKGROUND
The long-term durability and prognostic significance of improvement in renal function after mechanical circulatory support (MCS) has yet to be characterized in a large multicenter population. The primary goals of this analysis were to describe serial post-MCS changes in estimated glomerular filtration rate (eGFR) and determine their association with all-cause mortality.


METHODS AND RESULTS
Adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with serial creatinine levels available (n=3363) were studied. Early post-MCS, eGFR improved substantially (median improvement, 48.9%; P<0.001) with 22.3% of the population improving their eGFR by ≥100% within the first few weeks. However, in the majority of patients, this improvement was transient, and by 1 year, eGFR was only 6.7% above the pre-MCS value (P<0.001). This pattern of early improvement followed by deterioration in eGFR was observed with both pulsatile and continuous-flow devices. Interestingly, poor survival was associated with both marked improvement (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.19-2.26; P=0.002) and worsening in eGFR (adjusted HR, 1.63; 95% CI, 1.15-2.13; P=0.004).


CONCLUSIONS
Post-MCS, early improvement in renal function is common but seems to be largely transient and not necessarily indicative of an improved prognosis. This pattern was observed with both pulsatile and continuous-flow devices. Additional research is necessary to better understand the mechanistic basis for these complex post-MCS changes in renal function and their associated survival disadvantage.


CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00119834.
['Brisco|Meredith A|MA|', 'Kimmel|Stephen E|SE|', 'Coca|Steven G|SG|', 'Putt|Mary E|ME|', 'Jessup|Mariell|M|', 'Tang|Wilson W H|WW|', 'Parikh|Chirag R|CR|', 'Testani|Jeffrey M|JM|']
D000368:Aged D005260:Female D005500:Follow-Up Studies D005919:Glomerular Filtration Rate D006333:Heart Failure D006353:Heart-Assist Devices D006801:Humans D053208:Kaplan-Meier Estimate D007668:Kidney D008297:Male D008875:Middle Aged D015995:Prevalence D011379:Prognosis D012042:Registries D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate D016896:Treatment Outcome
cardio-renal syndrome heart failure heart-assist devices transplantation