Prevalence and prognostic importance of changes in renal function after mechanical circulatory support

Circ Heart Fail. 2014 Jan;7(1):68-75. doi: 10.1161/CIRCHEARTFAILURE.113.000507. Epub 2013 Nov 8.


Background: The long-term durability and prognostic significance of improvement in renal function after mechanical circulatory support (MCS) has yet to be characterized in a large multicenter population. The primary goals of this analysis were to describe serial post-MCS changes in estimated glomerular filtration rate (eGFR) and determine their association with all-cause mortality.

Methods and results: Adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with serial creatinine levels available (n=3363) were studied. Early post-MCS, eGFR improved substantially (median improvement, 48.9%; P<0.001) with 22.3% of the population improving their eGFR by ≥100% within the first few weeks. However, in the majority of patients, this improvement was transient, and by 1 year, eGFR was only 6.7% above the pre-MCS value (P<0.001). This pattern of early improvement followed by deterioration in eGFR was observed with both pulsatile and continuous-flow devices. Interestingly, poor survival was associated with both marked improvement (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.19-2.26; P=0.002) and worsening in eGFR (adjusted HR, 1.63; 95% CI, 1.15-2.13; P=0.004).

Conclusions: Post-MCS, early improvement in renal function is common but seems to be largely transient and not necessarily indicative of an improved prognosis. This pattern was observed with both pulsatile and continuous-flow devices. Additional research is necessary to better understand the mechanistic basis for these complex post-MCS changes in renal function and their associated survival disadvantage.

Clinical trial registration: URL: Unique identifier: NCT00119834.

Keywords: cardio-renal syndrome; heart failure; heart-assist devices; transplantation.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology*
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Heart-Assist Devices*
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Outcome

Associated data