Kidney Week

Abstract: TH-PO047

Changes in eGFR after Acute Mechanical Circulatory Support in Patients with Acute Heart Failure

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Jahan, Nusrath, Tufts University School of Medicine, Boston, Massachusetts, United States

Nusrath Jahan

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart, MS

• Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States

Michael S. Kiernan, MD

• Sarnak, Hannah Leigh, Tufts Medical Center, Boston, Massachusetts, United States

Hannah Leigh Sarnak

• Lee, Ki Jung, Tufts Medical Center, Boston, Massachusetts, United States

Ki Jung Lee, MD

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle, MD

• Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States

Tatsufumi Oka, MD, PhD

• Moises, Amanda I., Tufts University School of Medicine, Boston, Massachusetts, United States

Amanda I. Moises

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak, MD, MS

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum, MD, MS

Background

It has been suggested that estimated glomerular filtration rate (eGFR) may improve among patients admitted for acute heart failure (AHF) following hemodynamic support with acute mechanical circulatory support (MCS), but descriptions of changes in eGFR are limited.

Methods

Among adult patients admitted to an academic medical center from 2015-21 for a primary diagnosis of AHF requiring a pulmonary artery (PA) catheter, we examined the subgroup requiring acute MCS. Using the CKD-EPI 2021 equation, we examined absolute change in eGFR from one day prior to acute MCS placement to 7-days after placement. Patients on inotropes or MCS prior to admission were excluded.

Results

Of 755 patients, 53 (7%) required the use of acute MCS. Mean (SD) age was 58 (13) years, 11 (21%) were women; median [IQR] baseline eGFR was 50 [30, 69] ml/min/1.73 m². Initial acute MCS device was an intra-aortic balloon pump in 44 (83%), Impella in 7 (13%), and extracorporeal membrane oxygenation in 2 (4%) patients. At 1-day post-MCS, 26 patients (49%) had an eGFR increase, 26 patients (49%) had an eGFR decrease, and one patient started renal replacement therapy. By 7-days post-MCS, 7 (13%) patients had died or transitioned to hospice. Of those who survived to 7-days, overall the eGFR increased by 2.8 (IQR -2.1, 14.9) ml/min/1.73 m², with 32 patients (70%) had an eGFR increase (median [IQR] increase by 9.0 [2.4, 21.6] mL/min/1.73 m²) while 14 patients (30%) had an eGFR decrease (median decrease of -10.6 [-27.7, -4.0] mL/min/1.73 m²). There was no difference in eGFR change by device type (Table). Age, sex, baseline comorbidities including hypertension and diabetes were no different between those with eGFR increase versus decrease.

Conclusion

Among patients admitted for AHF requiring PA catheter to guide management, of the subgroup needing acute MCS support, about two-thirds had a mild improvement in eGFR with MCS support. However, one-third had a decline in eGFR despite cardiac support, without any identifiable differences in baseline characteristics to distinguish those with increase or decrease in eGFR.

Funding

• NIDDK Support