Left Ventricular Assist Device Outcomes In Patients With Chronic Kidney Disease And End-stage Renal Disease

Abstract

<h3>Background</h3> There is paucity of data regarding Left ventricular Assist Device (LVAD) outcomes in patients with advanced Chronic kidney disease (CKD) and End Stage Renal Disease (ESRD). <h3>Methods</h3> We conducted a retrospective study utilizing United States Renal Database (2006-2016) to compare 1-year outcomes between Medicare beneficiaries with ESRD to 5% sample of Medicare beneficiaries with CKD among LVAD patients. Comorbidities and outcomes were identified using appropriate ICD9 or ICD-10 codes. Patients who underwent heart transplant in follow up were excluded prior to obtaining outcomes. Subgroup analysis of CKD patients with available staging information [n=181(41.2%)] was explored to study CKD stage impact on outcomes. <h3>Results</h3> There were 482 patients with CKD and 192 patients with ESRD who underwent LVAD implantation. The ESRD group were 5 years younger and had more females compared to CKD group. Non-ischemic cardiomyopathy was more common in CKD vs ESRD (45.2% vs 23.9%, p <0.001). The details of baseline characteristics are shown in Table 1. The 1-year mortality is higher in ESRD when compared to CKD group (68.3% vs 35.5%, p <0.001). Median time to mortality in ESRD was 22 days (IQR; 6-55) and 46 days (IQR; 19-153) in CKD group. Out of patients with available baseline CKD staging, 91.2% had advanced CKD (stage III and above). Subgroup analysis in this cohort showed trend of increase in mortality from III (33.9%) to IV/V (40.9%). There were no significant differences in bleeding, pump thrombosis, stroke and sepsis/infection between two groups. <h3>Conclusions</h3> The patients with ESRD who receive LVAD have worse survival when compared to CKD group. There is also trend of gradual increase in mortality with worsening renal function. This information will help in shared decision making while considering advance heart failure therapies in CKD or ESRD patients.