Is Intermittent Hemodialysis Safe in Patients with a Continuous Flow Left Ventricular Assist Device?

Abstract

Purpose Dialysis centers are wary of performing intermittent hemodialysis (HD) on patients with continuous flow (CF) left ventricular assist devices (LVAD) because of the potential for volume flux related complications and Doppler probe dependent blood pressure monitoring. We report the conduct of HD in patients with LVAD (Heart Mate II), identify events requiring modification of or termination of HD and their management. Methods and Materials We abstracted clinical data from dialysis session on all patients who underwent intermittent HD following placement of LVAD at our institution. Results From June 2009 to October 2012, 139 patients received LVAD at our institution, 10 (7%) required intermittent HD post-operatively. Mean age was 53±14yrs, 90% were male. A total of 281 HD sessions were administered amounting to 1,025 hours of HD. Mean systolic blood pressure monitored with Doppler was 97±18mmHg. Dialysis durations averaged 218±18 mins, mean blood flow rate was 334±38 cc/min and 2.6±1.1 L was ultrafiltrated during each HD session. Only 15 (5.3%) HD sessions were interrupted or terminated in 6 patients, due to symptomatic hypotension 6, asymptomatic hypotension 3, ventricular tachycardia terminated with AICD 1, HD machine malfunction 2, low phosphorus 2 and abdominal cramps 1. Volume expansion was necessary on 3 occasions in 2 patients both of whom were transferred to intensive care unit for sepsis. Low flow LVAD alarms were registered during 2 of the symptomatic hypotension episodes. No serious adverse effect i.e. MI, LVAD thrombosis or stroke was observed. Conclusions Intermittent HD with standard blood flow and ultrafiltration rates were well tolerate in patients with CF LVAD. Hypotension, LVAD dysfunction or serious adverse effects requiring termination of HD were infrequent. Reason for terminating HD Frequency (%) Symptomatic Hypotension 6 (2) Aymptomatic Hypotension 3 (1) HD machine malfunction 2 (0.7) Low phosphorus 2 (0.7) Abdominal cramps 1 (0.36) Ventricular tachycardia 1 (0.36) Total 15 (5.3)