AKI diagnoses rising as ventricular assist device placement for heart failure increases
Click Here to Manage Email Alerts
A published study found diagnoses of acute kidney injury have increased in hospitalized patients with heart failure undergoing ventricular assist device placement, a procedure which is also occurring more frequently.
“Ventricular assist devices (VADs) are used for end-stage heart failure not amenable to medical therapy,” Carl P. Walther, MD, MS, of the Selzman Institute for Kidney Health, and colleagues wrote. “Acute kidney injury (AKI) in this setting is common due to heart failure decompensation, surgical stress, and other factors. Little is known about national trends in AKI diagnosis and AKI requiring dialysis (AKI-D) and associated outcomes with VAD implantation.”
Using data from the National Impatient Sample, researchers included 24,140 hospitalized patients who underwent implantable VAD placement between 2006 to 2015, determining whether AKI was also diagnosed (AKI diagnosed in 56.1% of all hospitalizations; AKI-D diagnosed in 6.5%). In-hospital mortality, length of stay and estimated hospitalization costs were also considered.
Researchers found that as hospitalizations with VADs placed increased from 853 in 2006 to 3,945 in 2015, AKI diagnosis also increased during these hospitalizations (44% in 2006 to 2007 to 61.7% in 2014 to 2015). On the other hand, AKI requiring dialysis decreased from 9.3% in 2006 to 2007 to 5.2% in 2014 to 2015. Researchers also noted that, compared with those with no AKI, hospital costs were 19.1% higher in patients diagnosed with AKI and 39.6% higher in patients diagnosed with AKI requiring dialysis.
Regarding mortality, researchers observed a decline in those not diagnosed with AKI and in those with AKI not requiring dialysis. Mortality in patients with AKI requiring dialysis remained stable.
They pointed out that the timing of AKI remains unclear, indicating an important limitation of the study.
They wrote, “[We] were not able to determine when during the hospitalizations AKI occurred (particularly before, during, or a after left ventricular assist device [LVAD] placement), and there are likely important pathophysiologic differences and perhaps differences in outcomes and costs as well, comparing those who have AKI before LVAD placement (likely due to [heart failure] HF decompensation), those with AKI due to the surgery itself, and those with AKI during late complications after the LVAD implantation.”
They added, “[As] VADs are increasingly used in the management of end-stage HF refractory to medical management, understanding and ameliorating pre- and postoperative decreases in kidney function is necessary.” – by Melissa J. Webb
Disclosures: Walther reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts