Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis

Joshua M. Friedland-Little, Borah J. Hong, Jeffrey G. Gossett, Shriprasad R. Deshpande, Sabrina Law, Kathryn A. Hollifield, Ryan S. Cantor, Devin Koehl, Steven J. Kindel, Mark Turrentine, Ryan R. Davies

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Renal dysfunction (RD) is prevalent among pediatric patients with advanced heart failure. Data are limited regarding changes in renal function after left ventricular assist device (LVAD) placement in this population. METHODS: Pediatric LVAD recipients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 and June 30, 2016 were included. Longitudinal changes in renal function were analyzed for the entire cohort as well as subgroups stratified by patient and device characteristics. Logistic regression was used to attempt to identify factors associated with lack of improvement in renal function after LVAD placement. Post-LVAD outcomes were assessed using the Kaplan‒Meier method. RESULTS: Data from 247 patients from 39 centers were analyzed. Baseline RD (estimated glomerular filtration rate [eGFR] <90 ml/min/1.73 m2) was present in 150 (61%) patients. Overall, eGFR improved post-LVAD, peaking at 1 month post-implant. There was an inverse relationship between baseline eGFR and the degree of improvement at 1 month. Degree of improvement in eGFR at 1 month was not impacted by device type, age, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, or diagnosis. Failure to normalize renal function at 1 week was correlated with persistent RD at 1 month. Post-implant outcomes did not differ among patients stratified by pre-implant renal function. CONCLUSIONS: Renal function improves post-LVAD placement in pediatric patients regardless of age, diagnosis, illness severity, or device type, with improvement most pronounced in patients with baseline RD. Identifying patients with irreversible renal dysfunction before LVAD placement remains difficult. Pre-LVAD renal function does not appear to impact survival to transplant.

Original languageEnglish (US)
Pages (from-to)1218-1225
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Heart-Assist Devices
Pediatrics
Kidney
Glomerular Filtration Rate
Equipment and Supplies
Registries
Heart Failure
Logistic Models

Keywords

  • eGFR
  • heart transplant
  • left ventricular assist device
  • LVAD
  • pediatric
  • Pedimacs
  • renal function

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Friedland-Little, J. M., Hong, B. J., Gossett, J. G., Deshpande, S. R., Law, S., Hollifield, K. A., ... Davies, R. R. (2018). Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis. Journal of Heart and Lung Transplantation, 37(10), 1218-1225. https://doi.org/10.1016/j.healun.2018.06.016

Changes in renal function after left ventricular assist device placement in pediatric patients : A Pedimacs analysis. / Friedland-Little, Joshua M.; Hong, Borah J.; Gossett, Jeffrey G.; Deshpande, Shriprasad R.; Law, Sabrina; Hollifield, Kathryn A.; Cantor, Ryan S.; Koehl, Devin; Kindel, Steven J.; Turrentine, Mark; Davies, Ryan R.

In: Journal of Heart and Lung Transplantation, Vol. 37, No. 10, 01.10.2018, p. 1218-1225.

Research output: Contribution to journalArticle

Friedland-Little, JM, Hong, BJ, Gossett, JG, Deshpande, SR, Law, S, Hollifield, KA, Cantor, RS, Koehl, D, Kindel, SJ, Turrentine, M & Davies, RR 2018, 'Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis', Journal of Heart and Lung Transplantation, vol. 37, no. 10, pp. 1218-1225. https://doi.org/10.1016/j.healun.2018.06.016
Friedland-Little, Joshua M. ; Hong, Borah J. ; Gossett, Jeffrey G. ; Deshpande, Shriprasad R. ; Law, Sabrina ; Hollifield, Kathryn A. ; Cantor, Ryan S. ; Koehl, Devin ; Kindel, Steven J. ; Turrentine, Mark ; Davies, Ryan R. / Changes in renal function after left ventricular assist device placement in pediatric patients : A Pedimacs analysis. In: Journal of Heart and Lung Transplantation. 2018 ; Vol. 37, No. 10. pp. 1218-1225.
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abstract = "BACKGROUND: Renal dysfunction (RD) is prevalent among pediatric patients with advanced heart failure. Data are limited regarding changes in renal function after left ventricular assist device (LVAD) placement in this population. METHODS: Pediatric LVAD recipients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 and June 30, 2016 were included. Longitudinal changes in renal function were analyzed for the entire cohort as well as subgroups stratified by patient and device characteristics. Logistic regression was used to attempt to identify factors associated with lack of improvement in renal function after LVAD placement. Post-LVAD outcomes were assessed using the Kaplan‒Meier method. RESULTS: Data from 247 patients from 39 centers were analyzed. Baseline RD (estimated glomerular filtration rate [eGFR] <90 ml/min/1.73 m2) was present in 150 (61{\%}) patients. Overall, eGFR improved post-LVAD, peaking at 1 month post-implant. There was an inverse relationship between baseline eGFR and the degree of improvement at 1 month. Degree of improvement in eGFR at 1 month was not impacted by device type, age, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, or diagnosis. Failure to normalize renal function at 1 week was correlated with persistent RD at 1 month. Post-implant outcomes did not differ among patients stratified by pre-implant renal function. CONCLUSIONS: Renal function improves post-LVAD placement in pediatric patients regardless of age, diagnosis, illness severity, or device type, with improvement most pronounced in patients with baseline RD. Identifying patients with irreversible renal dysfunction before LVAD placement remains difficult. Pre-LVAD renal function does not appear to impact survival to transplant.",
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T1 - Changes in renal function after left ventricular assist device placement in pediatric patients

T2 - A Pedimacs analysis

AU - Friedland-Little, Joshua M.

AU - Hong, Borah J.

AU - Gossett, Jeffrey G.

AU - Deshpande, Shriprasad R.

AU - Law, Sabrina

AU - Hollifield, Kathryn A.

AU - Cantor, Ryan S.

AU - Koehl, Devin

AU - Kindel, Steven J.

AU - Turrentine, Mark

AU - Davies, Ryan R.

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Y1 - 2018/10/1

N2 - BACKGROUND: Renal dysfunction (RD) is prevalent among pediatric patients with advanced heart failure. Data are limited regarding changes in renal function after left ventricular assist device (LVAD) placement in this population. METHODS: Pediatric LVAD recipients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 and June 30, 2016 were included. Longitudinal changes in renal function were analyzed for the entire cohort as well as subgroups stratified by patient and device characteristics. Logistic regression was used to attempt to identify factors associated with lack of improvement in renal function after LVAD placement. Post-LVAD outcomes were assessed using the Kaplan‒Meier method. RESULTS: Data from 247 patients from 39 centers were analyzed. Baseline RD (estimated glomerular filtration rate [eGFR] <90 ml/min/1.73 m2) was present in 150 (61%) patients. Overall, eGFR improved post-LVAD, peaking at 1 month post-implant. There was an inverse relationship between baseline eGFR and the degree of improvement at 1 month. Degree of improvement in eGFR at 1 month was not impacted by device type, age, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, or diagnosis. Failure to normalize renal function at 1 week was correlated with persistent RD at 1 month. Post-implant outcomes did not differ among patients stratified by pre-implant renal function. CONCLUSIONS: Renal function improves post-LVAD placement in pediatric patients regardless of age, diagnosis, illness severity, or device type, with improvement most pronounced in patients with baseline RD. Identifying patients with irreversible renal dysfunction before LVAD placement remains difficult. Pre-LVAD renal function does not appear to impact survival to transplant.

AB - BACKGROUND: Renal dysfunction (RD) is prevalent among pediatric patients with advanced heart failure. Data are limited regarding changes in renal function after left ventricular assist device (LVAD) placement in this population. METHODS: Pediatric LVAD recipients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 and June 30, 2016 were included. Longitudinal changes in renal function were analyzed for the entire cohort as well as subgroups stratified by patient and device characteristics. Logistic regression was used to attempt to identify factors associated with lack of improvement in renal function after LVAD placement. Post-LVAD outcomes were assessed using the Kaplan‒Meier method. RESULTS: Data from 247 patients from 39 centers were analyzed. Baseline RD (estimated glomerular filtration rate [eGFR] <90 ml/min/1.73 m2) was present in 150 (61%) patients. Overall, eGFR improved post-LVAD, peaking at 1 month post-implant. There was an inverse relationship between baseline eGFR and the degree of improvement at 1 month. Degree of improvement in eGFR at 1 month was not impacted by device type, age, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, or diagnosis. Failure to normalize renal function at 1 week was correlated with persistent RD at 1 month. Post-implant outcomes did not differ among patients stratified by pre-implant renal function. CONCLUSIONS: Renal function improves post-LVAD placement in pediatric patients regardless of age, diagnosis, illness severity, or device type, with improvement most pronounced in patients with baseline RD. Identifying patients with irreversible renal dysfunction before LVAD placement remains difficult. Pre-LVAD renal function does not appear to impact survival to transplant.

KW - eGFR

KW - heart transplant

KW - left ventricular assist device

KW - LVAD

KW - pediatric

KW - Pedimacs

KW - renal function

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