Abstract Background Percutaneous micro-axial ventricular assist device (pVAD), a promising alternative to improve prognosis in patients with cardiogenic shock, was previously reported to be associated with acute kidney injury (AKI). In the current study, further insights of AKI associated with pVAD were investigated and compared to intra-aortic balloon pumping (IABP) in patients requiring mechanical cardiac support (MCS). Methods In this single-center study, consecutive 245 patients who required pVAD or IABP from January 2017 to June 2024 were retrospectively evaluated. AKI was identified based on the guidelines from the Kidney Disease Improving Global Outcomes (KDIGO). The occurrences of AKI and requiring renal replacement therapy (RRT) were evaluated and compared between the two groups. Results Of all patients, 86 (35%) received pVAD and 159 (65%) IABP. The occurrence of AKI and RRT was significantly higher in the pVAD group than the IABP group (57% vs. 35%, p=0.001 and 30% vs. 15%, p=0.005) (Figure1A). On cox regression multivariable analysis, pVAD use was associated with the occurrence of AKI (HR 2.25 (1.11-4.57), p=0.025), whereas changes in estimated glomerular filtration rate (eGFR) between during support and after removal of devices were significantly greater in the pVAD group than the IABP group (6.55 vs. -1.24 mL/min/1.73m2, p=0.038) (Figure1B). Although AKI was an independent predictor for 180 days mortality in total patients (p=0.0007), pVAD-related AKI was not associated with the mortality (p=0.61) (Figure2). For the further analysis in the pVAD group, low ejection fraction (EF), hemolysis, chronic kidney disease (CKD) and support duration were associated with increased risk of AKI. Conclusions The use of pVAD was associated with increased risk of AKI, however pVAD-related AKI did not mainly contribute to mortality. There may be possibility of decreasing risk of AKI with appropriate management.
Kusumoto et al. (Sat,) studied this question.
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