Impact of Renal Dysfunction on Outcomes after Left Ventricular Assist Device: A Systematic Review

BACKGROUND AND OBJECTIVES: Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from left ventricular assist device (LVAD) therapy. The effect of preoperative renal dysfunction on clinical outcomes after LVAD implantation remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes post-LVAD in patients with and without renal dysfunction. METHODS: PubMed, MEDLINE, and Embase databases were searched for studies comparing outcomes in patients with and without renal dysfunction who underwent LVAD implantation for advanced heart failure. The primary outcome of all-cause mortality was reported as random effects risk ratio (RR) with 95% confidence interval (CI). RESULTS: Our search yielded 5,229 potentially eligible studies. We included 7 studies reporting on 26,652 patients. Patients with renal dysfunction (glomerular filtration rate [GFR] <60 mL/min/1.73 m(2)) (n=4,630) had increased risk of all-cause mortality (RR, 2.21; 95% CI, 1.39–3.51; p<0.01) compared to patients with normal renal function (GFR >60 mL/min/1.73 m(2)) (n=22,019). CONCLUSIONS: Patients with renal dysfunction have increased mortality after LVAD implantation when compared to patients with normal renal function. GFR can be used to risk stratify patients and guide decision making prior to LVAD therapy.