Background: 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).Methods: 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.Results: 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 < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00-6.70) and 2.22 (95% CI, 1.62-3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58-12.33) and 5.41 (95% CI, 3.63-8.06), respectively.Conclusion: 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.

中文翻译：

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急性肾损伤对植入式左心室辅助装置患者的发生率和影响：荟萃分析。


背景：我们的目的是评估植入式左心室辅助装置 (LVAD) 患者的急性肾损伤 (AKI) 发生率及其相关死亡风险。方法：通过 Ovid MEDLINE、EMBASE 和 Cochrane 数据库进行系统文献检索2020 年 1 月，确定提供植入式 LVAD 成年患者 AKI 发生率和 AKI 相关死亡风险数据的研究。使用 DerSimonian-Laird 的随机效应、通用逆方差方法检查汇总效应估计。结果：本荟萃分析纳入了 56 项队列研究，涉及 63,663 名 LVAD 患者。报告的 AKI 的汇总发生率为 24.9% (95%CI: 20.1%-30.4%)，但当应用 RIFLE、AKIN 和 KDIGO 的 AKI 标准定义时，上升至 36.9% (95%CI: 31.1%-43.1%)标准。需要肾脏替代治疗 (RRT) 的严重 AKI 的汇总发生率为 12.6% (95%CI: 10.5%-15.0%)。 AKI 发生率在 LVAD 类型 (p = .35) 或 LVAD 使用指征 (p = .62) 之间没有显着差异。虽然荟萃回归分析并未证明研究年份与总体 AKI 发生率之间存在显着相关性 (p = .55)，但研究年份与需要 RRT 的严重 AKI 发生率呈负相关（斜率 = -0.068，p < .001） 。 AKI 患者 30 天和一年时死亡率的汇总比值比 (OR) 分别为 3.66 (95% CI, 2.00-6.70) 和 2.22 (95% CI, 1.62-3.04)。需要 RRT 的严重 AKI 患者 30 天和一年时死亡率的汇总 OR 分别为 7.52 (95% CI, 4.58-12.33) 和 5.41 (95% CI, 3.63-8.06)。 结论：我们发现不止一个- 三分之一的 LVAD 患者根据标准定义出现 AKI，13% 的患者出现需要 RRT 的严重 AKI。 LVAD 患者需要 RRT 的严重 AKI 发生率可能有所改善。 LVAD 患者的 AKI 与 30 天和 1 年死亡率增加相关。