Advanced Kidney Disease Limits LVAD Survival

Abstract

Background Left ventricular assist device (LVAD) therapy has dramatically improved survival for patients with end-stage heart failure (HF). Chronic kidney disease (CKD) is common in these patients yet how CKD impacts LVAD outcomes is unclear. Methods Using the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) from 2010-2014, patients with CKD were identified in the following ways: a) Cr>3 b) any dialysis within 48 hours of implant c) destination therapy patients for whom CKD was listed as a contraindication to transplant. Survival for these patients were then compared to those patients without CKD adjusting for age, gender, and INTERMACS profile. Results A total of 5581 patients were included for analysis during this time period. Of these, 124 (2.2%) patients had a Cr of >3, 88 (1.6%) patients had dialysis within 48 hours of implant and 565 (10.1%) patients were designated DT for CKD. There was overlap between these 3 groups with 40 patients having both a Cr of >3 and designated DT for CKD, 28 patients with both a Cr of >3 and who had dialysis within 48 hours of implant, 31 patients both designated DT for CKD and who had dialysis within 48 hours of implant, and 12 patients shared across all three groups. When defining CKD by Cr > 3, patient survival at 1 year was 65.4% compared to 79.8% for those with Cr of 3 or less (Panel A). If defined by undergoing dialysis, 1 - year survival was 56.7% compared to 79.9% for patients not on dialysis (Panel B). For the 565 patients recorded as not eligible for transplant due to CKD, survival was 71.1% compared to 80.5% in the rest of the population (Panel C). Conclusion Regardless of how significant CKD was defined, survival was lower than those patients without significant CKD after adjusting for age, sex, INTERMACs profile. Significant renal disease limits survival with LVAD therapy.