CARD26: Renal replacement therapy after Left Ventricular Assist Device (LVAD) placement: a single center post hospitalization outcome analysis

Background: Historically, advanced chronic kidney disease (CKD) stage 4 or greater and dialysis are often considered to be a relative contraindication for left ventricular assist device (LVAD) implantation. We aim to describe our experience with advanced CKD patients receiving LVADs. Methods: Data was collected by retrospective chart review at our institution. We reviewed all CKD patients who underwent durable LVAD placement requiring perioperative renal replacement therapy (RRT) at our institution between November 2014 and July 2021. Fifty-nine patients were identified, inclusive of patients acutely requiring perioperative RRT and those going on to require chronic RRT. Clinical events of interest included need for dialysis, mortality, infection, thrombotic events, bleeding, and readmission rates at 1, 3, 6 and 12 months. Data was analyzed using multivariate logistic regression. Results: Of the 59 patients, 88.7% were male with an average age of 56 years. Twenty eight had HeartMate III (HM3) LVAD, 24 had HVAD and 7 had HMII. Patients with CKD at baseline were stratified by their pre-VAD CKD stages and majority fell in CKD stage 3a/b. Table 1 depicts further analysis for patients with CKD and non-CKD pre-VAD. CKD stage prior to LVAD did not show a correlation with the need for dialysis post implant (p=0.34, table 2). Conclusion: In this small, single center, retrospective analysis, pre-VAD CKD stage is not necessarily predictive of dialysis. Furthermore, no significant difference was identified between CKD and non-CKD patients. Further studies to determine risk factors for dialysis and subsequent morbidity and mortality in this population to appropriately characterize risk for CKD patients will be of utmost importance.