Improvement in Kidney Function After Ventricular Assist Device Implantation and Its Influence on Thromboembolism, Hemorrhage, and Mortality.
Improvement in Kidney Function After Ventricular Assist Device Implantation and Its Influence on Thromboembolism, Hemorrhage, and Mortality.
复制标题
心室辅助装置植入后肾功能的改善及其对血栓栓塞、出血和死亡率的影响。
DOI：
10.1097/mat.0000000000000989
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Limdi,NitaA
中科院分区：
文献类型：
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作者：
Davis,BrittneyH;Boehme,AmeliaK;Pamboukian,SalpyV;Allon,Michael;George,JamesF;Dillon,Chrisly;Kirklin,JamesK;Tallaj,Jose;Levitan,EmilyB;Griffin,Russell;McGwinJr,Gerald;Beasley,TMark;Limdi,NitaA
虽然心脏移植仍然是治疗心力衰竭的金标准，但心室辅助装置（VAD）已成为可行的替代方案。VAD植入可改善肾功能。然而，这种改善是否持续或与改善的结果有关尚不清楚。在此，我们评估了VAD患者的肾功能改善、改善的预测因素以及与血栓栓塞、出血和死亡率的相关性。使用慢性肾病（CKD）分期定义肾功能：阶段1（肾小球滤过率[eGFR]≥ 90 ml/min/1.73 m2），2期（eGFR 60-90 ml/min/1.73 m 2），3a期73 m2）、3b期（eGFR 30-44 ml/min/1.73 m2）、4期（eGFR 15-30 ml/min/1.73 m2）和5期（eGFR< 15 ml/min/1.73 m2）。肾功能改善定义为eGFR改善，导致CKD分期变为较轻严重程度。植入后肾功能改善，除基线5期CKD患者外，所有患者的肾功能均维持1年以上。植入时年龄较小（OR 0.93，95%CI：0.90-0.96，P< 0.0001）与肾功能持续改善相关。肾功能不佳与死亡率增加有关，但与血栓栓塞或出血无关。与基线eGFR> 45 ml/min/1.73 m2的患者相比，eGFR< 45 ml/min/1.73 m2的患者死亡风险更高。（对于3b期，HR 3.32，95%CI：1.10-9.98，p= 0.03;对于4期，HR 4.07，95%CI：1.27-13.1，p= 0.02;对于5期CKD，HR 4.01，95%CI：1.17-13.7，p= 0.03）。肾功能与血栓栓塞或出血无关，持续改善与死亡风险降低无关。然而，植入时肾功能差与死亡风险增加相关。
Although heart transplantation remains the gold standard for management of heart failure, ventricular assist devices (VAD) have emerged as viable alternatives. VAD implantation improves kidney function. However, whether the improvement is sustained or associated with improved outcomes is unclear. Herein we assess kidney function improvement, predictors of improvement, and associations with thromboembolism, hemorrhage, and mortality in VAD patients. Kidney function was defined using chronic kidney disease (CKD) stages: stage 1 (glomerular filtration rate [eGFR]≥ 90 ml/min/1.73 m 2), stage 2 (eGFR 60–90 ml/min/1.73 m 2), stage 3a (eGFR 45–59 ml/min/1.73 m 2), stage 3b (eGFR 30–44 ml/min/1.73 m 2), stage 4 (eGFR 15–30 ml/min/1.73 m 2), and stage 5 (eGFR< 15 ml/min/1.73 m 2). Improvement in kidney function was defined as an improvement in eGFR that resulted in a CKD stage change to one of lesser severity. Kidney function improved post implant, and was maintained over 1 year for all patients, except those with baseline stage 5 CKD. Younger age at implantation (OR 0.93, 95% CI: 0.90–0.96, P< 0.0001) was associated with sustained improvement in kidney function. Poor kidney function was associated increased mortality but not with thromboembolism or hemorrhage. Compared to patients with baseline eGFR> 45 ml/min/1.73 m 2; patients with eGFR< 45 ml/min/1.73 m 2 had a higher mortality risk (HR 3.32, 95% CI: 1.10–9.98, p= 0.03 for stage 3b; HR 4.07, 95% CI: 1.27–13.1, p= 0.02 for stage 4; and HR 4.01, 95% CI: 1.17–13.7, p= 0.03 for stage 5 CKD). Kidney function was not associated with thromboembolism or hemorrhage, and sustained improvement was not associated with lower risk of death. However, poor kidney function at implantation was associated with an increased risk of mortality.