Preoperative acute kidney injury predicts the need for post-LVAD renal replacement therapy

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BACKGROUND: Postoperative renal failure following LVAD implantation is known to negatively impact outcomes. However, the role of preoperative predictors of renal failure remains unclear. Therefore, we sought to identify and assess preoperative factors potentially predictive of postoperative acute kidney injury (AKI) requiring renal replacement therapy (RRT) in destination therapy LVAD patients. METHODS: A retrospective review of all primary LVAD implantations at a single, destination therapy center from 2022 to 2024 was conducted. LVAD exchanges were excluded. The primary outcome was postoperative AKI requiring RRT. Independent predictors of postoperative RRT were assessed using multivariable logistic regression modeling. The impact of postoperative RRT on survival was assessed using the Kaplan-Meier method. RESULTS: In total, 103 patients underwent primary LVAD implantation. The mean preoperative creatinine was 1.37 ± 0.46 mg/dL with an eGFRCr of 66.60 ± 35.25 mL/min/1.73m2. Twenty-one patients (20.39%) required postoperative RRT. Preoperative creatinine (OR: 4.64 [1.24–17.32], p = 0.02), proteinuria (OR: 3.52 [1.15–10.82], p = 0.03), and preoperative AKI (OR: 3.57 [1.03–12.37], p = 0.04) were all independently associated with increased risk of postoperative RRT. The need for RRT was associated with increased operative mortality (19.05% vs. 1.22%, p < 0.001) and decreased 1-year survival (42.59% vs. 87.97%, p < 0.001). CONCLUSIONS: The need for RRT after LVAD implantation is associated with a high operative and short-term mortality. In our series of high acuity and surgically complex patients, the preoperative variables identified as the best predictors of postoperative RRT were baseline creatinine, baseline proteinuria, and preoperative AKI.

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