Abstract
Introduction
Although preoperative kidney function has been associated with left ventricular assist
device (LVAD) outcomes, most previous estimates of glomerular filtration rates (eGFRs)
have utilized race in the calculation. Recently, novel eGFR equations independent
of race have been suggested and validated. Therefore, we undertook this study to evaluate
the predictive value of a novel, non–race-based eGFR calculation on short-term LVAD
outcomes.
Methods
We conducted a retrospective review of all primary LVAD implants from 2017 to 2022
at our institution. eGFR was calculated using the novel Chronic Kidney Disease Epidemiology
Collaboration 2021 formula (CKD-EPI 2021). eGFR was also calculated according to the
Modification of Diet in Renal Disease equation for historical reference. Primary stratification
was by eGFR: ≥60, 30-60, and <30. The primary outcome was 1-y survival. Multivariable
Cox proportional hazards regression modeling was used to further evaluate the impact
of kidney function on 1-y mortality.
Results
From 2017 to 2022, 91 patients underwent LVAD implantation with a HeartMate 3 device.
The average age was 65.20 ± 11.08, 77 (84.62%) were male, and 14 (15.38%) were Black.
The mean CKD-EPI 2021 eGFR was 56.07 ± 23.55 compared with 54.72 ± 26.37 as calculated
by Modification of Diet in Renal Disease (P = 0.719). Overall, 30-d and 1-y survival was 96.7% and 85.0%, respectively. When
stratified by eGFR, there was a significant difference in 1-y survival (≥60, 93.46%;
30-60, 87.36%; <30, 62.75%; P = 0.016). On multivariable analysis, a preoperative eGFR <30 was associated with
an increased hazard of 1-y mortality (5.58 [1.06-29.17], P = 0.043).
Conclusions
In conclusion, non–race-based estimates of renal function are predictive of short-term
LVAD outcomes. Further investigation of this phenomenon is warranted.
Keywords
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Article info
Publication history
Published online: November 19, 2022
Accepted:
October 18,
2022
Received in revised form:
August 29,
2022
Received:
July 11,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
