Chronic Kidney Disease and Left Ventricular Assist Device Patients: A Retrospective Review

• Published in: Journal of cardiac failure Vol. 25; no. 8; p. S165
• Main Authors: Chickerillo, Krystina, Andrade, Ambar A., Kukla, Lisa, Khan, Muhammad, Hussain, Sheraz, Krause, Nora, Aicher, Tracy, Paliga, Robin, Hughes, Kylie, Johnson, Christine, Graney, Nicole, Nitti, Kara, Pauwaa, Sunil, Macaluso, Gregory, Joshi, Anjali, Sciamanna, Christopher, Dia, Muhyaldeen, Cotts, William G., Tatooles, Antone J., Pappas, Pat S.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2019
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2019.07.470

Left ventricular assist device (LVAD) implantation remains a valuable long-term option for patients with end-stage heart failure. Often these patients present with multiple comorbidities, including concomitant renal dysfunction. Patients with renal dysfunction prior to LVAD implantation are considered to be at increased risk for bleeding, right ventricular dysfunction, and mortality. Due to this increased risk, it is suggested that patients with end-stage renal disease (ESRD) should be excluded from LVAD implantation, unless they are being considered for heart and kidney transplantation. No current guidelines are provided for chronic kidney disease (CKD) stage 3-5 patients who are implanted with an LVAD. We intend to examine outcomes in these patients. We retrospectively investigated all patients with CKD stage 3-5 who received a durable LVAD at our institution from January 2015 until December 2017. Those patients who underwent a second LVAD implantation or were lost to follow up were excluded from the analysis. CKD stage 3-5 was defined by eGFR <15 - 59 mL/min/1.73m3, utilizing the eGFR noted within 24 hours prior to LVAD implantation. Of the 293 patients who underwent LVAD implantation between January 2015 until December 2017, 135 were identified to have CKD stage 3-5. 82.2% of patients had CKD stage 3, 9.6% had CKD stage 4, and 8.2% had CKD stage 5. The median eGFR was 44 mL/min/1.73m3 prior to LVAD implantation and 51 mL/min/1.73m3 after implantation. 62.2% had diabetes and 76.3% had hypertension. The adverse event rates were as follows: 62.2% bleeding (including gastrointestinal bleeding, epistaxis, and mediastinal hemorrhage), 29.9% bacteremia, 22.2% hemolysis, 20% stroke, and 11.9% had home inotropes for right ventricular dysfunction. After implantation, 28.2% required renal replacement therapy (RRT). 7% of patients requiring RRT had persistent renal failure, and required hemodialysis at the time of discharge. 74% of patients were implanted as DT, and 11.9% underwent heart transplantation. The 1- year survival rate was 80.7%, with 63.7% of the cohort alive presently. Our findings suggest that those patients with eGFR <15-59 mL/min/1.73m3 can successfully undergo LVAD implantation, especially those listed for heart and/or heart and kidney transplantation. While these patients still may experience adverse events, survival analyses suggest that these patients should still be considered for LVAD implantation. Our limitations include difficulty in identifying true CKD stages in these patients with dynamic insults or improvements with hemodynamic optimization. More studies are needed to understand ways to decrease adverse event rates in this patient population.