Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study.

Autor:	Verma S; Department of Internal Medicine, University of South Florida, Tampa, FL, USA., Bassily E; Department of Internal Medicine, University of South Florida, Tampa, FL, USA., Leighton S; Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL, USA., Mhaskar R; Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL, USA., Sunjic I; Department of Internal Medicine, University of South Florida, Tampa, FL, USA., Martin A; Department of Internal Medicine, University of South Florida, Tampa, FL, USA., Rihana N; Department of Internal Medicine, University of South Florida, Tampa, FL, USA., Jarmi T; Department of Nephrology and Hypertension, University of South Florida, Tampa, FL, USA., Bassil C; Department of Nephrology and Hypertension, University of South Florida, Tampa, FL, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical medicine research [J Clin Med Res] 2017 Jul; Vol. 9 (7), pp. 596-604. Date of Electronic Publication: 2017 May 22.
DOI:	10.14740/jocmr3039w
Abstrakt:	Background: Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated. Methods: In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed. The two groups were evaluated at baseline and at 3 and 6 months after LVAD or inotrope therapy was started. The incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), BTT rate, and mortality for 6 months following LVAD or inotrope therapy were studied. Results between the groups were compared using Mann-Whitney U test and Chi-square with continuity correction or Fischer's exact at the significance level of 0.05. Results: Mean glomerular filtration rate (GFR) was not statistically different between the two groups, with P = 0.471, 0.429, and 0.847 at baseline, 3 and 6 months, respectively. The incidence of AKI, RRT, and BTT was not statistically different. Mortality was less in the inotrope group (P < 0.001). Conclusion: Intravenous inotrope therapy in end-stage heart failure patients is non-inferior for mortality, incidence of AKI, need for RRT, and renal function for 6-month follow-up when compared to LVAD therapy. Further studies are needed to compare the effectiveness of inotropes versus LVAD implantation on renal function and outcomes over a longer time period.
Databáze:	MEDLINE
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