What question did this study set out to answer?

The study aims to analyze the connection between acute kidney injury and haemolysis, and their effects on short-term outcomes in cardiogenic shock patients using microaxial flow pumps.

February 8, 2026

Impact of microaxial flow pumps on acute kidney injury in cardiogenic shock

Key Points

The study aims to analyze the connection between acute kidney injury and haemolysis, and their effects on short-term outcomes in cardiogenic shock patients using microaxial flow pumps.
Retrospective analysis of patients with cardiogenic shock receiving left-sided microaxial flow pumps.
Evaluation of acute kidney injury incidence and haemolysis in relation to clinical outcomes.
Collection of observational data from routine clinical care.
67% of patients experienced acute kidney injury, with 51% requiring continuous veno-venous hemofiltration (CVVHD).
Patients needing CVVHD showed a significantly lower successful weaning rate from microaxial flow pumps (24% vs. 54%).
30-day mortality was much higher in those requiring CVVHD (51% vs. 8%).
Haemolysis was seen more frequently in patients with AKI compared to those without (78% vs. 22%).

Abstract

Abstract Background Microaxial flow pumps (mAFP) can improve survival in STEMI-related cardiogenic shock (CS) but are associated with high complication rates, including acute kidney injury (AKI) and continuous veno-venous hemofiltration (CVVHD) use, as well as haemolysis. Purpose We aimed to evaluate the relationship between AKI and haemolysis, and the impact of these on short term clinical outcomes in patients with CS on mAFP support. Methods In a retrospective single centre study of patients with CS treated with left-sided mAFP, we evaluated the relationship between AKI, haemolysis and clinical outcomes on consecutive patients. Observational data collected as part of routine care were analysed. Results Among 82 patients (median IQR age: 57 50-63 years, 82% male, median IQR BMI 25.0 22.1-29.5), CS was of ischaemic aetilogy in 51% and non-ischaemic in 49%. At baseline, 1% (n=1) had end-stage renal disease, and 12% (n=10) had chronic kidney disease (CKD, eGFR 60 mL/min/1.73m²). AKI occurred in 67% of patients (n=55/82), with 51% (n=42/82) requiring CVVHD. CVVHD was started in 82% of patients by day 2 post-mAFP implantation. Indications for CVVHD were anuria (49%), anuria with fluid overload (27%), fluid overload alone (16%), and acidosis (8%) (Figure 1). CVVHD duration was 7 4-22 days (median IQR) . At initiation, median urine output was 10 mL/hour, with mean creatinine 243 ± 96 µmol/L, urea 17.6 ± 7.2 mmol/L, and potassium 4.7 ± 0.7 mmol/L. During mAFP, haemolysis (plasma-free haemoglobin 40 mg/dL) was more frequently observed in patients with AKI than those with out AKI (78% vs 22%, p= 0.0196) and in those requiring vs those not requiring CVVHD (64% vs 36%, p= 0.033) (Figure 1). Patients who required CVVHD had a much lower likelihood of successful weaning from mAFP (24% vs 54%, p=0.011) and higher 30-day mortality (51% vs 8%, p0.0001). CVVHD patients also had lower likelihood of being bridged to transplantation with mAFP (4% vs 59%, p=0.0002). Conclusion Among patients with CS supported with mAFP, AKI and progression to CVVHD are extremely frequent. Haemolysis occurs more frequently in patients with AKI. AKI, and in particular CVVHD, is strongly associated with adverse outcomes, including higher mortality, lower recovery and transplantation rates. Further research is needed to evaluate the relationship between AKI and haemolysis and ways to reduce AKI in this cohort.Figure 1 Figure 2

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