Andrew Abadeer
M.D., M. Eng |
Resident Physician at Medstar Georgetown
Doctor of Medicine (M.D.)
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Columbia University College of Physicians and Surgeons
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Master of Engineering - MEng
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Stevens Institute of Technology
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Bachelor of Engineering (B.E.)
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Stevens Institute of Technology
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Objective

Although the outcomes of patients with cardiogenic shock remain poor, short-term mechanical circulatory support has become an increasingly popular modality for hemodynamic assistance and organ preservation. Because the kidney is exquisitely sensitive to poor perfusion, acute kidney injury is a common sequela of cardiogenic shock. This study examines the incidence and clinical impact of acute kidney injury in patients with short-term mechanical circulatory support for cardiogenic shock.

Methods

Retrospective review was performed of 293 consecutive patients with cardiogenic shock who were treated with short-term mechanical circulatory support. The well-validated 2014 Kidney Disease Improving Global Outcomes criteria were used to stage acute kidney injury. Outcomes of interest were long-term mortality and renal recovery.

Results

Acute kidney injury developed in 177 of 293 patients (60.4%), of whom 113 (38.6%) were classified with stage 3 (severe). Kaplan–Meier survival estimates indicated a 1-year survival of 49.2% in the nonsevere (stages 0-2) acute kidney injury cohort versus 27.3% in the severe acute kidney injury cohort (P < .001). Multivariable Cox regression demonstrated that severe acute kidney injury was a predictor of long-term mortality (hazard ratio, 1.54; confidence interval, 1.10-2.14; P = .011). Among hospital survivors, renal recovery occurred more frequently (82.4% vs 63.2%, P = .069) and more quickly (5.6 vs 24.5 days, P < .0001) in the nonsevere than in the severe acute kidney injury group.
Conclusions

Acute kidney injury is common and frequently severe in patients in cardiogenic shock treated with short-term mechanical circulatory support. Milder acute kidney injury resolves with survival comparable to patients without acute kidney injury. Severe acute kidney injury is an independent predictor of long-term mortality. Nonetheless, many surviving patients with acute kidney injury do experience gradual renal recovery.
Importance of stratifying acute kidney injury in cardiogenic shock resuscitated with mechanical circulatory support therapy
The Journal of Thoracic and Cardiovascular Surgery
http://www.sciencedirect.com/science/article/pii/S0022522317308620
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Orange County, CA
Andrew Abadeer
Software Engineer at McDonald's
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United States
Andrew Abadeer
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South Carolina, United States
andrew abadeer
Driver at amazon
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United States
Andrew Abadeer
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