Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A meta-analysis
Karthik Kovvuru, Swetha R Kanduri, Charat Thongprayoon, Tarun Bathini, Saraschandra Vallabhajosyula, Wisit Kaewput, Michael A Mao, Wisit Cheungpasitporn, Kianoush B Kashani
Karthik Kovvuru, Swetha R Kanduri, Division of Nephrology, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
Charat Thongprayoon, Wisit Cheungpasitporn, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
Tarun Bathini, Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
Saraschandra Vallabhajosyula, Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
Wisit Kaewput, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Michael A Mao, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
Kianoush B Kashani, Department of Medicine, Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Kovvuru K, Kanduri S, Thongprayoon C and Cheungpasitporn W acquired data and designed the research; Bathini T, Vallabhajosyula S interpreted the data and performed research; Kanduri S, Kaewput W, Mao MA analyzed the data and drafted the article; Kovvuru K, Cheungpasitporn W, Kashani KB revised the article and contributed to final approval.
Conflict-of-interest statement: The authors declared no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Wisit Cheungpasitporn, FACP, Associate Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States. wcheungpasitporn@gmail.com
Received: April 3, 2021
Peer-review started: April 3, 2021
First decision: June 5, 2021
Revised: June 7, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 9, 2021
Processing time: 215 Days and 8.4 Hours
ARTICLE HIGHLIGHTS
Research background
Acute kidney injury (AKI) is a common (37%) and severe complication after left ventricular assist device (LVAD) implantation, and 13% require kidney replacement therapy (KRT). Severe AKI requiring KRT in LVAD patients is associated with high short-term and long-term mortality compared with those without KRT.
Research motivation
While recovery of kidney function is associated with better outcomes, the recovery rates of kidney function among LVAD patients with severe AKI-KRT are unclear.
Research objectives
To demonstrate the rates of kidney recovery among patients with AKI-KRT after LVAD implantation.
Research methods
Eligible articles were searched through Ovid MEDLINE, EMBASE, and the Cochrane Library. The inclusion criteria included adult patients with recovery from severe AKI-KRT after LVAD placement, which is defined by regained kidney function resulting in discontinuation of KRT.
Research results
A total of 268 patients from 14 cohort studies with severe AKI-KRT after LVAD were enrolled. Follow-up time ranges from 2 wk of LVAD implantation up to 12 mo. 78.5% of kidney recovery occurred at the time of hospital discharge or within 30 d. The majority (85%) of patients used continuous-flow LVAD. Overall, the pooled estimated AKI recovery rates among patients with severe AKI-KRT were 50.5% (95%CI: 34.0%-67.0%). While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated the pooled estimated AKI recovery rates among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate (P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.
Research conclusions
Recovery from severe AKI-KRT after LVAD occurs approximately 50.5%, and it has not significantly changed over the years despite advances in medicine.
Research perspectives
Our study results offer a perspective of rates of kidney recovery after AKI-KRT among patients with LVAD implantation. As recovery of kidney functions is associated with improved outcomes compared to those with no AKI recovery, we suggest a meticulous approach to monitoring patients post AKI and acute kidney disease in achieving early and complete kidney recovery.
