Short-term Outcomes Of Intermittent Hemodialysis In Patients With Ventricular Assist Devices

Introduction There is little evidence about the short-term outcomes of patients undergoing implantation of ventricular assist devices (VADs) who require initiation of chronic intermittent hemodialysis (IHD). Filling this knowledge gap may help anticipate potential complications and improve outcomes. Methods This is a chart review, retrospective study that included all patients who underwent VAD implantation followed by initiation of IHD at our center. Intermittent hemodialysis was defined as ≤6-hour sessions, 3-4 times weekly. Continuous renal replacement therapy (CRRT) did not meet this inclusion criteria. Continuous and categorical variables were expressed in means (standard deviation) and numbers (%), respectively. Results Among the 11 patients that met inclusion criteria, 6 (54.6%) were female, 6 (54.6%) were African American, 6 (54.6%) had non-ischemic cardiomyopathy, 6 were being bridged to HT, and 9 (81.8%) had chronic kidney disease. Home regimen was available for 10 patients, all of whom were taking loop diuretics, but only 7 (70%) and 3 (30%) of them had medical regimens with ACEIs or ARBs, and spironolactone, respectively. All patients received tunneled catheters, and in 2 of them AV fistulas were performed afterwards. At least 3 patients experienced asymptomatic hypotension (<60 mm Hg) during the first 10 IHD sessions, leading to finishing the session early in one of the cases. Another patient had catheter thrombosis leading to catheter exchange. No other major event was documented during the 10 initial IHD sessions. One patient started IHD outpatient without complications. Among the 10 (90.9%) patients who started IHD during index hospitalization, the length of hospital stay was 81.5 (±40.7) days, and their most relevant complications were death (1), stroke (1), infections (5), gastrointestinal bleeding (4), right ventricular failure (2), and tracheostomy (1). For those who started IHD during index hospitalization, time to first readmission was 44.6 (±36.3) days, with 4 (44.4%) patients being readmitted within 30 days, and 1 of them dying during the first readmission. Additional information is found in Table 1. Conclusions This study confirms feasibility of IHD initiation after VAD implantation, even as outpatient, but also proves a high burden of morbidity during index hospitalization and short-term follow up. Larger studies prospective studies with the newest VADs could provide valuable insight into this strategy for left ventricular and renal replacement therapies. There is little evidence about the short-term outcomes of patients undergoing implantation of ventricular assist devices (VADs) who require initiation of chronic intermittent hemodialysis (IHD). Filling this knowledge gap may help anticipate potential complications and improve outcomes. This is a chart review, retrospective study that included all patients who underwent VAD implantation followed by initiation of IHD at our center. Intermittent hemodialysis was defined as ≤6-hour sessions, 3-4 times weekly. Continuous renal replacement therapy (CRRT) did not meet this inclusion criteria. Continuous and categorical variables were expressed in means (standard deviation) and numbers (%), respectively. Among the 11 patients that met inclusion criteria, 6 (54.6%) were female, 6 (54.6%) were African American, 6 (54.6%) had non-ischemic cardiomyopathy, 6 were being bridged to HT, and 9 (81.8%) had chronic kidney disease. Home regimen was available for 10 patients, all of whom were taking loop diuretics, but only 7 (70%) and 3 (30%) of them had medical regimens with ACEIs or ARBs, and spironolactone, respectively. All patients received tunneled catheters, and in 2 of them AV fistulas were performed afterwards. At least 3 patients experienced asymptomatic hypotension (<60 mm Hg) during the first 10 IHD sessions, leading to finishing the session early in one of the cases. Another patient had catheter thrombosis leading to catheter exchange. No other major event was documented during the 10 initial IHD sessions. One patient started IHD outpatient without complications. Among the 10 (90.9%) patients who started IHD during index hospitalization, the length of hospital stay was 81.5 (±40.7) days, and their most relevant complications were death (1), stroke (1), infections (5), gastrointestinal bleeding (4), right ventricular failure (2), and tracheostomy (1). For those who started IHD during index hospitalization, time to first readmission was 44.6 (±36.3) days, with 4 (44.4%) patients being readmitted within 30 days, and 1 of them dying during the first readmission. Additional information is found in Table 1. This study confirms feasibility of IHD initiation after VAD implantation, even as outpatient, but also proves a high burden of morbidity during index hospitalization and short-term follow up. Larger studies prospective studies with the newest VADs could provide valuable insight into this strategy for left ventricular and renal replacement therapies.