Concurrent Use of Kidney Replacement Therapy and Temporary Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis
Abstract
UNLABELLED: Introduction: The use of temporary-left ventricular assist devices (T-LVADs) for circulatory support in cardiogenic shock is increasing along with complications like acute kidney injury requiring kidney replacement therapy (KRT). While KRT is linked to mortality in cardiogenic shock, data on mortality in patients receiving both T-LVAD and KRT are limited.
METHODS: We conducted a systematic review and meta-analysis, searching three databases from inception through December 30, 2023, for studies reporting on patients with concurrent T-LVAD and KRT support during cardiogenic shock. We performed random-effects meta-analyses, looking at in-hospital mortality as our primary outcome. Subgroup analysis was performed based on the continent, timing of KRT, and type of T-LVAD. Risk of bias was assessed with the Joanna Briggs Institute checklists and certainty of evidence with the GRADE approach.
RESULTS: We included 35 studies after screening through 89 full-text articles, consisting of 2,277 individuals receiving T-LVAD and 722 (30.9%, 95% CI: 25.8-36.6) receiving concurrent KRT. In-hospital mortality was pooled across 6 studies, with 91 non-survivors (65.5%) among 139 individuals (95% CI: 57.2-72.9). Concurrent KRT and T-LVAD was associated with higher in-hospital (OR 3.48, 95% CI: 2.20-5.49) and overall mortality (OR 2.19, 95% CI: 1.01-4.76) compared to patients not on KRT. The proportion of patients on KRT was significantly (p interaction = 0.0004) larger in Europe…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,277 participants or records.
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