Renal Replacement Therapy Rare, Not Independently Linked to Higher Mortality in Children With VAD Placement: Study
USA: Renal dysfunction requiring renal replacement therapy (RRT) is uncommon in children undergoing ventricular assist device (VAD) placement. Although these patients had more severe clinical illness and higher mortality, RRT itself was not independently associated with mortality, suggesting that underlying disease severity may be the primary driver of poor outcomes.
The findings come from a new study published in The Annals of Thoracic Surgery by Michael A. Catalano, MD, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, and colleagues. The researchers examined outcomes among pediatric patients requiring dialysis at the time of VAD implantation, focusing on survival, heart transplantation, and outcomes following transplantation.
VADs are increasingly used to provide mechanical circulatory support in children with severe heart failure while they recover, undergo transplantation, or receive longer-term support. However, significant kidney dysfunction can complicate the management of critically ill patients and has been associated with poorer outcomes in adults receiving VAD support. Data specifically describing children requiring dialysis around VAD implantation have remained limited.
The investigators analyzed data from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Registry, which includes pediatric VAD patients treated at 57 North American centers. The analysis covered patients undergoing VAD implantation between April 2018 and June 2025.
Patients were categorized according to whether they required RRT at the time of VAD surgery, including those receiving chronic dialysis and those who had recently started RRT. Patient characteristics, clinical status before implantation, and outcomes after VAD placement were evaluated. The researchers assessed one-year survival, likelihood of receiving a heart transplant and survival after transplantation using survival and competing-risk analyses.
Among 1,607 pediatric patients who underwent VAD implantation, 75 (4.7%) required RRT at the time of surgery. Children receiving RRT generally presented with indicators of greater illness severity than those without RRT.
Key findings:
- RRT patients had a higher incidence of extracorporeal membrane oxygenation (ECMO) support, higher INTERMACS classification, and increased total bilirubin levels.
- Heart transplantation occurred in 33 of 75 RRT patients (44.0%), compared with 941 of 1,532 patients (61.4%) without RRT.
- One-year survival was lower among children requiring RRT, at 58.4% versus 78.3% in patients without RRT.
- Despite the difference in survival, multivariable analysis found that RRT was not independently associated with one-year mortality (HR 1.31).
The authors concluded that dialysis-dependent renal dysfunction is relatively uncommon among children receiving VADs and is associated with a more critical clinical profile and poorer observed survival. However, once other factors were considered, RRT itself did not independently predict mortality. The findings suggest that the severity of the underlying cardiovascular illness and overall clinical condition may have a greater role in determining outcomes than renal replacement therapy alone.
Reference:
Catalano, M. A., Edelson, J. B., Amdani, S., Shezad, M. F., Lorts, A., Rosenthal, D. N., Beqaj, H., Peng, D. M., Auerbach, S., Su, J., Greiten, L., Butts, R., Butto, A., Hsu, D., & Maeda, K. (2026). Outcomes of ventricular assist device placement in pediatric patients with renal dysfunction requiring dialysis: An ACTION registry analysis. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2026.09.014
Next Story