The impact of left ventricular assist devices on kidney function: a systematic review and meta-analysis

Abstract

Background Kidney dysfunction is common in patients with advanced heart failure and is associated with adverse clinical outcomes. Left ventricular assist device (LVAD) implantation may influence renal function through hemodynamic and cardiorenal changes. We performed a meta-analysis to evaluate longitudinal changes in estimated glomerular filtration rate (eGFR) following LVAD implantation. Results We systematically searched six databases for studies reporting eGFR before and after LVAD implantation until March 2026. The primary analysis used a multivariate random-effects meta-analysis to jointly pool repeated follow-up estimates while accounting for within-study dependence across time points. Pooled mean changes in eGFR and 95 confidence intervals (CIs) were estimated at 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, 1 year, 2 years, and 3 years after implantation. A total of 38 studies contributing 95 effect sizes were included. Compared with baseline, pooled mean eGFR was significantly higher at 1 week (18.83 mL/min/1.73 m & sup2;; 95 CI: 13.21, 24.46), 2 weeks (18.29; 95 CI: 12.11, 24.48), 1 month (23.77; 95 CI, 19.48, 28.07), 3 months (15.20; 95 CI: 10.95, 19.46), 6 months (7.97; 95 CI: 3.72, 12.22), 9 months (8.27; 95 CI: 2.10, 14.44), and 1 year (7.34; 95 CI: 2.83, 11.85), but not at 2 or 3 years. In subgroup analyses, studies with baseline eGFR < 60 mL/min/1.73 m & sup2; showed significant increases across all evaluated follow-up intervals, whereas those with baseline eGFR >= 60 mL/min/1.73 m & sup2; showed significant increases only through 3 months. Conclusions LVAD implantation was associated with higher eGFR during the early postoperative period, with the largest increase observed at 1 month. However, because most included studies were pre-post analyses without non-LVAD comparator groups, these findings should be interpreted cautiously and do not establish a causal effect. Future research should explore the long-term impact of LVAD on renal health to optimize care strategies and outcomes.