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Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy
BACKGROUND: Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. METHODS: Thirty-three patients im...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703997/ https://www.ncbi.nlm.nih.gov/pubmed/33253314 http://dx.doi.org/10.1371/journal.pone.0242931 |
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author | de Nattes, Tristan Litzler, Pierre-Yves Gay, Arnaud Nafeh-Bizet, Catherine François, Arnaud Guerrot, Dominique |
author_facet | de Nattes, Tristan Litzler, Pierre-Yves Gay, Arnaud Nafeh-Bizet, Catherine François, Arnaud Guerrot, Dominique |
author_sort | de Nattes, Tristan |
collection | PubMed |
description | BACKGROUND: Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. METHODS: Thirty-three patients implanted with a Heartmate II LVAD (Abbott, Inc, Chicago IL) were retrospectively studied. Hemolysis, Acute Kidney Injury (AKI) and the evolution of estimated Glomerular Filtration Rate were analyzed. Proximal Tubulopathy (PT) groups were defined according to proteinuria, normoglycemic glycosuria, and electrolytic disorders. The Receiver Operating Characteristic (ROC) curve was used to analyze threshold of LDH values associated with PT. RESULTS: Median LDH between PT groups were statistically different, 688 IU/L [642–703] and 356 IU/L [320–494] in the “PT” and “no PT” groups, respectively p = 0.006. To determine PT group, LDH threshold > 600 IU/L was associated with a sensitivity of 85.7% (95% CI, 42.1–99.6) and a specificity of 84.6% (95% CI, 65.1–95.6). The ROC's Area Under Curve was 0.83 (95% CI, 0.68–0.98). In the “PT” group, patients had 4.2 [2.5–5.0] AKI episodes per year of exposure, versus 1.6 [0.4–3.7] in the “no PT” group, p = 0.03. A higher occurrence of AKI was associated with subsequent development of Chronic Kidney Disease (CKD) (p = 0.02) and death (p = 0.05). CONCLUSIONS: LVADs-induced subclinical hemolysis is associated with proximal tubular functional alterations, which in turn contribute to the occurrence of AKI and subsequent CKD. Owing to renal toxicity of hemolysis, measures to reduce subclinical hemolysis intensity as canula position or pump parameters should be systematically considered, as well as specific nephroprotective therapies. |
format | Online Article Text |
id | pubmed-7703997 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-77039972020-12-03 Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy de Nattes, Tristan Litzler, Pierre-Yves Gay, Arnaud Nafeh-Bizet, Catherine François, Arnaud Guerrot, Dominique PLoS One Research Article BACKGROUND: Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. METHODS: Thirty-three patients implanted with a Heartmate II LVAD (Abbott, Inc, Chicago IL) were retrospectively studied. Hemolysis, Acute Kidney Injury (AKI) and the evolution of estimated Glomerular Filtration Rate were analyzed. Proximal Tubulopathy (PT) groups were defined according to proteinuria, normoglycemic glycosuria, and electrolytic disorders. The Receiver Operating Characteristic (ROC) curve was used to analyze threshold of LDH values associated with PT. RESULTS: Median LDH between PT groups were statistically different, 688 IU/L [642–703] and 356 IU/L [320–494] in the “PT” and “no PT” groups, respectively p = 0.006. To determine PT group, LDH threshold > 600 IU/L was associated with a sensitivity of 85.7% (95% CI, 42.1–99.6) and a specificity of 84.6% (95% CI, 65.1–95.6). The ROC's Area Under Curve was 0.83 (95% CI, 0.68–0.98). In the “PT” group, patients had 4.2 [2.5–5.0] AKI episodes per year of exposure, versus 1.6 [0.4–3.7] in the “no PT” group, p = 0.03. A higher occurrence of AKI was associated with subsequent development of Chronic Kidney Disease (CKD) (p = 0.02) and death (p = 0.05). CONCLUSIONS: LVADs-induced subclinical hemolysis is associated with proximal tubular functional alterations, which in turn contribute to the occurrence of AKI and subsequent CKD. Owing to renal toxicity of hemolysis, measures to reduce subclinical hemolysis intensity as canula position or pump parameters should be systematically considered, as well as specific nephroprotective therapies. Public Library of Science 2020-11-30 /pmc/articles/PMC7703997/ /pubmed/33253314 http://dx.doi.org/10.1371/journal.pone.0242931 Text en © 2020 de Nattes et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article de Nattes, Tristan Litzler, Pierre-Yves Gay, Arnaud Nafeh-Bizet, Catherine François, Arnaud Guerrot, Dominique Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title | Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title_full | Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title_fullStr | Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title_full_unstemmed | Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title_short | Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy |
title_sort | hemolysis induced by left ventricular assist device is associated with proximal tubulopathy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703997/ https://www.ncbi.nlm.nih.gov/pubmed/33253314 http://dx.doi.org/10.1371/journal.pone.0242931 |
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