Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis

We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD). A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird. Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%–30.4%) but rose to 36.9% (95%CI: 31.1%–43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%–15.0%). AKI incidence did not differ significantly between types of LVAD (p = .35) or indication for LVAD use (p = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (p = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = −0.068, p We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.本研究旨在评估植入式左心室辅助装置（implantable left ventricular assist devices, LVAD）患者的急性肾损伤（acute kidney injury, AKI）发生率及其相关死亡风险。本研究通过检索Ovid MEDLINE、EMBASE及Cochrane数据库截至2020年1月的文献，筛选出针对植入式LVAD成年患者的AKI发生率及AKI相关死亡风险相关数据的研究。采用DerSimonian-Laird随机效应通用逆方差法对合并效应量进行分析。本项荟萃分析共纳入56项队列研究，涉及63663名LVAD患者。基于文献报道的AKI合并发生率为24.9%（95%CI：20.1%~30.4%）；若采用RIFLE、AKIN及KDIGO标准定义的AKI，则合并发生率升至36.9%（95%CI：31.1%~43.1%）。需接受肾脏替代治疗（renal replacement therapy, RRT）的重症AKI合并发生率为12.6%（95%CI：10.5%~15.0%）。不同类型LVAD或LVAD植入适应证患者的AKI发生率无显著差异（p=0.35、p=0.62）。尽管荟萃回归分析未显示研究年份与总体AKI发生率存在显著关联（p=0.55），但研究年份与需接受RRT的重症AKI发生率呈负相关（斜率=-0.068，p）。本研究结果显示，基于标准定义，超过三分之一的LVAD患者会发生AKI，且13%的患者会发展为需接受RRT的重症AKI。LVAD患者需接受RRT的重症AKI发生率已出现潜在改善趋势。LVAD患者合并AKI与30天及1年死亡率升高显著相关。