Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients.
AKI
CKD
Continuous-flow VAD
End-stage heart failure
Kidney outcomes
Mechanical circulatory support
Ventricular assist device
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
16 Nov 2023
16 Nov 2023
Historique:
received:
26
05
2023
accepted:
13
09
2023
revised:
13
09
2023
medline:
17
11
2023
pubmed:
17
11
2023
entrez:
16
11
2023
Statut:
aheadofprint
Résumé
Continuous-flow ventricular assist devices (CF-VADs) are used increasingly in pediatric end-stage heart failure (ESHF) patients. Alongside common risk factors like oxidant injury from hemolysis, non-pulsatile flow constitutes a unique circulatory stress on kidneys. Post-implantation recovery after acute kidney injury (AKI) is commonly reported, but long-term kidney outcomes or factors implicated in the evolution of chronic kidney disease (CKD) with prolonged CF-VAD support are unknown. We studied ESHF patients supported > 90 days on CF-VAD from 2008 to 2018. The primary outcome was CKD (per Kidney Disease Improving Global Outcomes (KDIGO) criteria). Secondary outcomes included AKI incidence post-implantation and CKD evolution in the 6-12 months of CF-VAD support. We enrolled 134 patients; 84/134 (63%) were male, median age was 13 [IQR 9.9, 15.9] years, 72/134 (54%) had preexisting CKD at implantation, and 85/134 (63%) had AKI. At 3 months, of the 91/134 (68%) still on a CF-VAD, 34/91 (37%) never had CKD, 13/91 (14%) developed de novo CKD, while CKD persisted or worsened in 49% (44/91). Etiology of heart failure, extracorporeal membrane oxygenation use, duration of CF-VAD, AKI history, and kidney replacement therapy were not associated with different CKD outcomes. Mortality was higher in those with AKI or preexisting CKD. In the first multicenter study to focus on kidney outcomes for pediatric long-term CF-VAD patients, preimplantation CKD and peri-implantation AKI were common. Both de novo CKD and worsening CKD can happen on prolonged CF-VAD support. Proactive kidney function monitoring and targeted follow-up are important to optimize outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
BACKGROUND
Continuous-flow ventricular assist devices (CF-VADs) are used increasingly in pediatric end-stage heart failure (ESHF) patients. Alongside common risk factors like oxidant injury from hemolysis, non-pulsatile flow constitutes a unique circulatory stress on kidneys. Post-implantation recovery after acute kidney injury (AKI) is commonly reported, but long-term kidney outcomes or factors implicated in the evolution of chronic kidney disease (CKD) with prolonged CF-VAD support are unknown.
METHODS
METHODS
We studied ESHF patients supported > 90 days on CF-VAD from 2008 to 2018. The primary outcome was CKD (per Kidney Disease Improving Global Outcomes (KDIGO) criteria). Secondary outcomes included AKI incidence post-implantation and CKD evolution in the 6-12 months of CF-VAD support.
RESULTS
RESULTS
We enrolled 134 patients; 84/134 (63%) were male, median age was 13 [IQR 9.9, 15.9] years, 72/134 (54%) had preexisting CKD at implantation, and 85/134 (63%) had AKI. At 3 months, of the 91/134 (68%) still on a CF-VAD, 34/91 (37%) never had CKD, 13/91 (14%) developed de novo CKD, while CKD persisted or worsened in 49% (44/91). Etiology of heart failure, extracorporeal membrane oxygenation use, duration of CF-VAD, AKI history, and kidney replacement therapy were not associated with different CKD outcomes. Mortality was higher in those with AKI or preexisting CKD.
CONCLUSIONS
CONCLUSIONS
In the first multicenter study to focus on kidney outcomes for pediatric long-term CF-VAD patients, preimplantation CKD and peri-implantation AKI were common. Both de novo CKD and worsening CKD can happen on prolonged CF-VAD support. Proactive kidney function monitoring and targeted follow-up are important to optimize outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 37971519
doi: 10.1007/s00467-023-06190-8
pii: 10.1007/s00467-023-06190-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.
Références
O’Connor MJ, Rossano JW (2014) Ventricular assist devices in children. Curr Opin Cardiol 29:113–121
pubmed: 24270395
doi: 10.1097/HCO.0000000000000030
Rossano JW, Cherikh WS, Chambers DC et al (2018) The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: twenty-first pediatric heart transplantation report-2018; Focus theme: Multiorgan Transplantation. J Heart Lung Transplant 37:1184–1195
pubmed: 30293614
doi: 10.1016/j.healun.2018.07.018
Wehman B, Stafford KA, Bittle GJ et al (2016) Modern outcomes of mechanical circulatory support as a bridge to pediatric heart transplantation. Ann Thorac Surg 101:2321–2327
pubmed: 26912304
pmcid: 5524136
doi: 10.1016/j.athoracsur.2015.12.003
Burki S, Adachi I (2017) Pediatric ventricular assist devices: current challenges and future prospects. Vasc Health Risk Manag 13:177–185
pubmed: 28546755
pmcid: 5437969
doi: 10.2147/VHRM.S82379
May LJ, Montez-Rath ME, Yeh J et al (2016) Impact of ventricular assist device placement on longitudinal renal function in children with end-stage heart failure. J Heart Lung Transplant 35:449–456
pubmed: 26653933
doi: 10.1016/j.healun.2015.10.039
Friedland-Little JM, Hong BJ, Gossett JG et al (2018) Changes in renal function after left ventricular assist device placement in pediatric patients: a Pedimacs analysis. J Heart Lung Transplant 37:1218–1225
pubmed: 30293616
doi: 10.1016/j.healun.2018.06.016
Fraser CD Jr, Jaquiss RD, Rosenthalet DN et al (2012) Prospective trial of a pediatric ventricular assist device. N Engl J Med 367:532–541
pubmed: 22873533
doi: 10.1056/NEJMoa1014164
Prodhan P, Bhutta AT, Gossett JM et al (2013) Comparative effects of ventricular assist device and extracorporeal membrane oxygenation on renal function in pediatric heart failure. Ann Thorac Surg 96:1428–1434
pubmed: 23987896
doi: 10.1016/j.athoracsur.2013.05.083
Demirozu ZT, Etheridge WB, Radovancevic R et al (2011) Results of HeartMate II left ventricular assist device implantation on renal function in patients requiring post-implant renal replacement therapy. J Heart Lung Transplant 30:182–187
pubmed: 20888256
doi: 10.1016/j.healun.2010.08.019
Russell SD, Rogers JG, Milano CA et al (2009) Renal and hepatic function improve in advanced heart failure patients during continuous-flow support with the HeartMate II left ventricular assist device. Circulation 120:2352–2357
pubmed: 19933938
doi: 10.1161/CIRCULATIONAHA.108.814863
Hasin T, Topilsky Y, Schirger JA et al (2012) Changes in renal function after implantation of continuous-flow left ventricular assist devices. J Am Coll Cardiol 59:26–36
pubmed: 22192665
doi: 10.1016/j.jacc.2011.09.038
Sandner SE, Zimpfer D, Zrunek P et al (2008) Renal function after implantation of continuous versus pulsatile flow left ventricular assist devices. J Heart Lung Transplant 27:469–473
pubmed: 18442710
doi: 10.1016/j.healun.2007.12.012
Singh M, Shullo M, Kormos RL et al (2011) Impact of renal function before mechanical circulatory support on posttransplant renal outcomes. Ann Thorac Surg 91:1348–1354
pubmed: 21524442
doi: 10.1016/j.athoracsur.2010.10.036
Sandner SE, Zimpfer D, Zrunek P et al (2009) Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg 87:1072–1078
pubmed: 19324130
doi: 10.1016/j.athoracsur.2009.01.022
Muslem R, Caliskan K, Akin S et al (2018) Acute kidney injury and 1-year mortality after left ventricular assist device implantation. J Heart Lung Transplant 37:116–123
pubmed: 29174532
doi: 10.1016/j.healun.2017.11.005
Patel AM, Adeseun GA, Ahmed I et al (2013) Renal failure in patients with left ventricular assist devices. Clin J Am Soc Nephrol 8:484–496
pubmed: 23065497
doi: 10.2215/CJN.06210612
Givens RC, Topkara VK (2018) Renal risk stratification in left ventricular assist device therapy. Expert Rev Med Devices 15:27–33
pubmed: 29252053
doi: 10.1080/17434440.2018.1418663
Hollander SA, Cantor RS, Sutherland SM et al (2019) Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant. Pediatr Transplant 23:e13477
pubmed: 31124590
doi: 10.1111/petr.13477
Almond CS, Buchholz H, Massicotte P et al (2011) Berlin Heart EXCOR Pediatric ventricular assist device Investigational Device Exemption study: study design and rationale. Am Heart J 162:425–35.e6
pubmed: 21884857
doi: 10.1016/j.ahj.2011.05.026
Morales DLS, Rossano JW, VanderPluym C et al (2019) Third annual pediatric interagency registry for mechanical circulatory support (Pedimacs) report: preimplant characteristics and outcomes. Ann Thorac Surg 107:993–1004
pubmed: 30817920
doi: 10.1016/j.athoracsur.2019.01.038
Morales DLS, Adachi I, Peng DM et al (2020) Fourth annual pediatric interagency registry for mechanical circulatory support (Pedimacs) report. Ann Thorac Surg 110:1819–1831
pubmed: 33039359
doi: 10.1016/j.athoracsur.2020.09.003
Conway J, Miera O, Adachi I et al (2018) Worldwide experience of a durable centrifugal flow pump in pediatric patients. Semin Thorac Cardiovasc Surg 30:327–335
pubmed: 29551744
doi: 10.1053/j.semtcvs.2018.03.003
Sutcliffe DL, Pruitt E, Cantor RS et al (2018) Post-transplant outcomes in pediatric ventricular assist device patients: a PediMACS-Pediatric Heart Transplant Study linkage analysis. J Heart Lung Transplant 37:715–722
pubmed: 29373179
doi: 10.1016/j.healun.2017.12.004
Puri K, Andes MM, Tume SC et al (2019) Characteristics and outcomes of pediatric patients supported with ventricular assist device-a multi-institutional analysis. Pediatr Crit Care Med 20:744–752
pubmed: 31162368
doi: 10.1097/PCC.0000000000001966
Rosenthal DN, Almond CS, Jaquiss RD et al (2016) Adverse events in children implanted with ventricular assist devices in the United States: data from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). J Heart Lung Transplant 35:569–577
pubmed: 27197775
pmcid: 5113942
doi: 10.1016/j.healun.2016.03.005
Schwartz GJ, Muñoz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637
pubmed: 19158356
pmcid: 2653687
doi: 10.1681/ASN.2008030287
Mian AN, Schwartz GJ (2017) Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis 24:348–356
pubmed: 29229165
pmcid: 6198668
doi: 10.1053/j.ackd.2017.09.011
Cuzzolin L, Fanos V, Pinna B et al (2006) Postnatal renal function in preterm newborns: a role of diseases, drugs and therapeutic interventions. Pediatr Nephrol 21:931–938
pubmed: 16773403
doi: 10.1007/s00467-006-0118-2
Pasquali M, Bellasi A, Cianciolo G et al (2018) [Update 2017 of the KDIGO guidelines on chronic kidney disease-mineral and bone disorder (ckd-mbd). What are the real changes?]. G Ital Nefrol 35:2018-vol3
Devarajan P (2013) Pediatric acute kidney injury: different from acute renal failure but how and why. Curr Pediatr Rep 1:34–40
pubmed: 23525203
doi: 10.1007/s40124-012-0003-3
Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–c184
pubmed: 22890468
doi: 10.1159/000339789
Idrovo A, Afonso N, Price J et al (2021) Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist. Pediatr Nephrol 36:1109–1117
pubmed: 32462258
doi: 10.1007/s00467-020-04605-4
Heinzel FR, Hegemann N, Hohendanner F et al (2020) Left ventricular dysfunction in heart failure with preserved ejection fraction-molecular mechanisms and impact on right ventricular function. Cardiovasc Diagn Ther 10:1541–1560
pubmed: 33224773
pmcid: 7666919
doi: 10.21037/cdt-20-477
Adachi I, Khan MS, Guzmán-Pruneda FA et al (2015) Evolution and impact of ventricular assist device program on children awaiting heart transplantation. Ann Thorac Surg 99:635–640
pubmed: 25530089
doi: 10.1016/j.athoracsur.2014.10.010
Sensirivatana R, Kingwatanakul P, Futrakul P (1999) Renal perfusion and disease progression. J Med Assoc Thai 82:496–505
pubmed: 10443100
Leitch CA (2000) Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol 11:195–202
pubmed: 10978712
doi: 10.1016/S1058-9813(00)00050-3
Tsintoni A, Dimitriou G, Karatza AA (2020) Nutrition of neonates with congenital heart disease: existing evidence, conflicts and concerns. J Matern Fetal Neonatal Med 33:2487–2492
pubmed: 30608033
doi: 10.1080/14767058.2018.1548602
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263
pubmed: 951142
doi: 10.1542/peds.58.2.259
Schwartz GJ, Gauthier B (1985) A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 106:522–526
pubmed: 3973793
doi: 10.1016/S0022-3476(85)80697-1
Finney H, Newman DJ, Gruber W et al (1997) Initial evaluation of cystatin C measurement by particle-enhanced immunonephelometry on the Behring nephelometer systems (BNA, BN II). Clin Chem 43:1016–1022
pubmed: 9191555
doi: 10.1093/clinchem/43.6.1016
Kyhse-Andersen J, Schmidt C, Nordin G et al (1994) Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clin Chem 40:1921–1926
pubmed: 7923773
doi: 10.1093/clinchem/40.10.1921
Newman DJ (2002) Cystatin C. Ann Clin Biochem 39(Pt 2):89–104
pubmed: 11928770
doi: 10.1258/0004563021901847
Gubb S, Holmes J, Smith G et al (2020) Acute kidney injury in children based on electronic alerts. J Pediatr 220:14-20.e4
pubmed: 31955879
doi: 10.1016/j.jpeds.2019.11.019
Goldstein SL, Devarajan P (2010) Pediatrics: acute kidney injury leads to pediatric patient mortality. Nat Rev Nephrol 6:393–394
pubmed: 20585319
doi: 10.1038/nrneph.2010.67
Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38:933–939
pubmed: 20124891
doi: 10.1097/CCM.0b013e3181cd12e1
Chen S, Dykes JC, McElhinney DB et al (2017) Haemodynamic profiles of children with end-stage heart failure. Eur Heart J 38:2900–2909
pubmed: 29019615
doi: 10.1093/eurheartj/ehx456