Abstract: SA-PO968

Successful Placement and Follow Up of ESRD Patient on Peritoneal Dialysis with an LVAD

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Barta, Valerie Suzanne, Hofstra Northwell School of Medicine, GREAT NECK, New York, United States
  • Jhaveri, Kenar D., Hofstra Northwell School of Medicine, GREAT NECK, New York, United States
  • Wanchoo, Rimda, Hofstra Northwell School of Medicine, GREAT NECK, New York, United States
Background

Left ventricular assist devices(LVAD)s have been shown to improve cardiac function in patients with advanced congestive heart failure(CHF) that are refractory to medical therapy. LVADs are contraindicated in patients with end stage renal disease(ESRD) on hemodialysis(HD). Peritoneal dialysis(PD) is widely considered a contraindication as well, given the close proximity of the peritoneal catheter to the device as well as risk of systemic infections. We report a successful placement of LVAD in an ESRD patient on PD with short and long term follow up.

Methods

A 52 year old Caucasian male with ESRD secondary to chronic heart failure on PD for five years got evaluated for a heart-kidney transplantation. Due to the patient’s worsening heart failure and significant symptom burden, he underwent LVAD (HeartWare) placement while continuing PD. He tolerated the procedure well and there were no infectious complications related to his PD catheter. Post LVAD follow up his PD prescription has not required adjustment and his mean arterial pressures(MAP) have remained > 60 mm hg. As blood pressure monitoring is not possible in LVAD patients, MAP values using arterial Doppler ultrasound are used to assess volume status. His fluid management was adjusted using these MAP values in combination with physical exam. Nine months following the LVAD, the patient remains stable on PD awaiting heart-kidney transplantation.

Conclusion

Our case highlights that PD can be safely performed in LVAD patients. There were no complications with volume management, interrupted LVAD function or peritonitis in our patient. PD should not be a contraindication for placement of LVADs. Additionally, it is our recommendation that in cases of acute kidney injury requiring initiation of dialysis post LVAD, the option of PD should be offered.