Effect of Mechanical Circulatory Support on Kidney and Electrolyte Outcomes in Cardiogenic Shock: A Multinational, Real-World Cohort Study

Background: Mechanical circulatory support (MCS), including left and right ventricular assist devices (LVAD/RVAD) and extracorporeal membrane oxygenation (ECMO), is increasingly used in the management of cardiogenic shock (CS). However, its association with renal and metabolic complications remains poorly characterized in large-scale real-world populations. Methods: We analyzed data from the TriNetX Global Collaborative Network, comprising 148 healthcare organizations. Adult patients (≥18 years) with a diagnosis of cardiogenic shock (ICD-10: R57.0) were identified between 2005 and 2025. Patients who received MCS (ECMO, LVAD, or RVAD; Cohort A) were compared to those without MCS (Cohort B). Outcomes included mortality, acute kidney injury (AKI), end-stage renal disease (ESRD), need for continuous renal replacement therapy (CRRT), and electrolyte disturbances. Odds ratios (ORs), hazard ratios (HRs), and Kaplan-Meier survival analyses were performed. No propensity matching was applied. Results: Cohort A included 15,590 patients with CS who received MCS; Cohort B included 237,947 CS patients without MCS. Key findings Mortality: 49.7% vs. 44.6% (OR 1.22; p<0.001) AKI: 53.9% vs. 38.7% (OR 1.85; HR 1.42; p<0.001) ESRD: 13.3% vs. 8.9% (OR 1.57; p<0.001) CRRT: 0.4% vs. 0.2% (OR 2.71; p<0.001) Hyponatremia: 21.3% vs. 14.8% (OR 1.56; HR 1.36; p<0.001) Hypernatremia: 11.9% vs. 5.5% (OR 2.30; HR 2.00; p<0.001) Hypocalcemia: 7.8% vs. 3.9% (OR 2.10; p<0.001) Hyperkalemia: 22.7% vs. 14.7% (OR 1.71; p<0.001) Hypokalemia: 24.1% vs. 15.5% (OR 1.73; p<0.001) Hyperphosphatemia: 13.2% vs. 6.7% (OR 2.10; p<0.001) Kaplan-Meier curves showed significantly shorter survival and earlier onset of renal and electrolyte complications in the MCS group. Conclusion: Among patients with cardiogenic shock, the use of mechanical circulatory support is associated with increased risks of AKI, ESRD, CRRT, and a broad spectrum of electrolyte disturbances. These findings highlight the need for early nephrology involvement and stringent metabolic monitoring in CS patients receiving MCS.