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Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients

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Abstract

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

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

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

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.

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Acknowledgements

The authors gratefully acknowledge the support from all centers including Texas Children’s Hospital-Baylor College of Medicine, St. Louis Children’s Hospital-Washington University, and Lucile Packard Hospital-Stanford University for data collection and for making this study possible.

Author information

Authors and Affiliations

  1. Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children’s, Houston, TX, USA

    Alexandra Idrovo, Poyyapakkam Srivaths & Ayse Akcan-Arikan

  2. Renal Section, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Alexandra Idrovo

  3. Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Seth A. Hollander

  4. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School, St. Louis, MO, USA

    Tara M. Neumayr & Genevieve Munoz

  5. Division of Nephrology, Department of Pediatrics, Washington University School, St. Louis, MO, USA

    Tara M. Neumayr

  6. McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Cynthia Bell

  7. Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children’s, Houston, TX, USA

    Swati Choudhry & Jack Price

  8. Division of Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine/Texas Children’s, Houston, TX, USA

    Iki Adachi

  9. Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Scott Sutherland

  10. Department of Pediatrics Critical Care Section, Baylor College of Medicine, Texas Children’s, Houston, TX, USA

    Ayse Akcan-Arikan

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  1. Alexandra Idrovo
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Corresponding author

Correspondence to Alexandra Idrovo.

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Conflict of interest

IA (Iki Adachi) serves as a consultant/proctor for Berlin Heart, Inc., Medtronic, Inc., Abbott, Inc., and Jarvik, Inc. AAA’s (Ayse Akcan-Arikan) institution has received research funding from Bioporto, Baxter, Medtronic, and NIAID unrelated to this work. The other authors declared no potential conflicts of interest with respect to the review, authorship, and/or publication.

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Idrovo, A., Hollander, S.A., Neumayr, T.M. et al. Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients. Pediatr Nephrol 39, 1289–1300 (2024). https://doi.org/10.1007/s00467-023-06190-8

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  • DOI: https://doi.org/10.1007/s00467-023-06190-8

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