Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis
Charat Thongprayoon, Ploypin Lertjitbanjong, Wisit Cheungpasitporn, Panupong Hansrivijit, Tibor Fülöp, Karthik Kovvuru, Swetha Rani Kanduri, Paul W. Davis, Saraschandra Vallabhajosyula, Tarun Bathini, Kanramon Watthanasuntorn, Narut Prasitlumkum, Ronpichai Chokesuwattanaskul, Supawat Ratanapo, Michael A. Mao, Kianoush Kashani
Abstract
Background We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD).Methods A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird.Results Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%–30.4%) but rose to 36.9% (95%CI: 31.1%–43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%–15.0%). AKI incidence did not differ significantly between types of LVAD (p = .35) or indication for LVAD use (p = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (p = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = −0.068, p < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00–6.70) and 2.22 (95% CI, 1.62–3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58–12.33) and 5.41 (95% CI, 3.63–8.06), respectively.Conclusion We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.