The Role of Dialysis in Outcomes of LVAD Implantation in Chronic Kidney Disease Patients: Insights from US National Readmission Database

Abstract

BackgroundIn patients with chronic kidney disease (CKD) undergoing left ventricular assist device (LVAD) implantation, there is an increased risk of mortality and morbidity. However, data on in-hospital complications for CKD patients, specifically comparing those on dialysis and those not on dialysis, is limited. Consequently, our study seeks to examine outcomes and determinants of complications in these two groups of CKD patients during their LVAD implantation hospitalizations in the United States. Methods and ResultsUtilizing the National Readmission Database (2016-2020), we identified LVAD and CKD diagnoses through ICD-10 codes. From this data, we found a total of 5,499 hospitalizations for LVAD procedures involving CKD patients, with 12.3% (678 cases) of them undergoing dialysis (CKD-D) treatment. CKD-D patients with had a lower mean age (55.9years,SD-12.6) compared to those without (58.5years,SD-12.6;p=0.000). Baseline demographics and comorbidities were shown in Figure 1. CKD-D shown to be predictor of CV complications including Myocardial-infraction (MI)[OR 3.78 (95% CI 2.72-5.24), p<0.000], Sudden-cardiac-arrest (SCA) [OR 2.01 (1.51- 2.67), p<0.000], major-adverse-cardiac-and-cerebrovascular-events (macce) [OR 1.15 (1.08-1.22), p<0.01], stroke [OR 1.8(1.11-2.93), p=0.017] and death [OR 3.12(2.34-4.14),p=0.000], compared to no dialysis (Figure 2). Furthermore, CKD-D patients were associated with increased mean length (74 vs 39 days, p<0.000) and cost of hospitalization ($20,18,792 vs $11,73,391, p<0.00). ConclusionsLVAD patients with chronic kidney disease on dialysis experienced an elevated risk of myocardial infarction, sudden cardiac arrest, major adverse cardiac and cerebrovascular events, stroke, and death. Additionally, CKD-D was linked to longer hospital stays and higher hospitalization expenses.