HFSA ePoster Library

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.

Table 1. Baseline characteristics and outcomes

Patient	ACEI/ARB	VAD	VAD strategy	Year of VAD implantation	LOS, days	IHD initiation setting	Time to 1st readmission, days - Reason
36 YO F with ICM, CKD3	No	HM2	BTT	2011	65	IP	100 - Ruptured ovarian cyst
42 YO M with NICM, CKD3	-	HM2	-	2012	41	IP	9 - Subtherapeutic INR
54 YO F with ICM	Yes	HVAD	DT	2012	166	IP	41 - Femoral fracture
59 YO F with NICM, CKD3	Yes	HVAD	BTT	2013	54	IP	31 - HF exacerbation, subtherapeutic INR
48 YO F with NICM, CKD2	No	HM2	BTT	2013	109	IP	6 - Fever, ICH
66 YO F with ICM, CKD3	Yes	HM2	BTT	2014	35	IP	17 - Subarachnoid hemorrhage
51 YO F with NICM, CKD3	Yes	HM2	DT	2014	66	IP	84 - Subtherapeutic INR
66 YO M with NICM, CKD3	Yes	HM2	DT	2016	81	IP	89 - Subtherapeutic INR
60 YO M with ICM, CKD3	No	HM2	BTT	2016	73	IP	26 - Tunneled catheter related infection
64 YO M with NICM	Yes	HM3	BTT	2019	125	IP	N/A (died during index hospitalization)
50 YO M with ICM, CKD3	Yes	HM3	DT	2019	24	OP	378 - Liver biopsy for abnormal hepatic test
ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; BT, bridge to transplant; CKD2, chronic kidney disease stage 2; CKD3, chronic kidney disease stage 3; DT, destination therapy; F, female; HF, heart failure; HM, HeartMate; ICH, intracranial hemorrhage; ICM, ischemic cardiomyopathy; IHD, intermittent hemodialysis; IP, inpatient; LOS, length of hospital stay; M, male; N/A, not applicable; NICM, non-ischemic cardiomyopathy; OP, outpatient; VAD, ventricular assist device; YO, year old