Impact of Renal Dysfunction on Patients Undergoing Left Ventricular Assist Device Implantation

Abstract

Background Left ventricular assist devices (LVADs) are increasingly used as a bridge to transplant or destination therapy. Renal dysfunction often precludes patients from single organ heart transplantation. However, the effect of preoperative renal dysfunction on LVAD outcomes is often debated, with limited literature available. Hypothesis Patients with preoperative chronic kidney disease undergoing LVAD implantation have worse periprocedural outcomes. Methods All hospitalizations of patients with systolic heart failure with index LVAD implantation (ICD-9 procedure code 37.66) were identified from the 2008-2014 National Inpatient Sample. Patients were stratified based on whether they had preoperative chronic kidney disease (CKD stage 1-4) (diagnosis codes 585.X) or normal renal function. Outcomes including in-hospital mortality, LOS, cost of care, and postoperative complications were analyzed. Trends over time were determined using the Cochran Armitage and Cuzick tests. Multivariate models were constructed with logistic and linear regression (gamma function) using the discharge weights provided under NIS guidelines. These models were adjusted for age and comorbidities including hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and family history of myocardial infarction. Results In the 880 hospitalizations involving pre-op CKD and 2209 without CKD, no statistically significant differences were noted in in-hospital mortality, LOS or total charges (p>0.05) after adjusting for age and comorbidities. No significant trends were noted over the study period for in-hospital mortality, LOS, and cost for the two groups (p>0.05). Average cost of hospitalization was $852,745 and average LOS was 37 days. Patients with CKD tended to be older (58.6 vs. 54.0 years) with a higher proportion of males (84% vs. 74%) and included more patients of African American race (29% vs. 21%). Patients with CKD also had a higher proportion of Medicare patients. There were no significant differences between the two groups in postoperative atrial fibrillation or stroke, or the post-procedural need for dialysis catheters or hemodialysis. Conclusions CKD (Stage 1-4) did not have a significant impact on index LVAD implant hospitalization in terms of inpatient mortality, LOS, total charges, and postoperative complications.