Abstract: SA-PO687

Successful Home Hemodialysis in a Patient with an LVAD (Left Ventricular Assist Device)

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Ananthakrishnan, Shubha, UC Davis, Sacramento, California, United States
  • Janmohamed, Munir, UCSF, San Francisco, California, United States
Background

LVADs for end-stage heart failure are on the rise as a bridge to transplant, including in patients on dialysis. There are many technical and logistic challenges faced by patients with an LVAD, who dialyze at a dialysis center. Here we describe successful home hemodialysis by a patient with an LVAD, awaiting a combined heart-kidney transplant.

Methods

The patient is a 39 yr old African American male, with ESKD due to FSGS, formerly on peritoneal dialysis for 6 years, who started home hemodialysis in 2015. He also has a h/o non-ischemic cardiomyopathy with EF around 18%. Given cardiac status and pulmonary hypertension, a decision was made to implant a HeartWare® LVAD in March 2016 as a bridge to transplant, with a flow of 5L/min, speed 2400 RPM, pulsatility of 7. The patient continued on home hemodialysis after the LVAD insertion, caring for the LVAD equipment, drive line dressing changes, as well as performing home hemodialysis without a partner. Home hemodialysis was performed using the NxStage® platform, Qb 400 ml/min, Flow fraction 35%, 1K, 3Ca bath, 5 days a week, using a L forearm AV fistula. BPs were controlled to goal SBP < 100 mm Hg targeting optimal dry weight and medication use. The patient had palpable radial pulses and was able to record blood pressures at home using a standard BP cuff and monitor. Warfarin anticoagulation was used for VAD patency, with goal INR 2-2.5. The patient did not require ESA therapy and was able to maintain Hb around 10 – 12 with intermittent iron alone. Other labs of interest: standard Kt/V 2.11, Albumin 4.3, Ca 9.3, Phos 4.9, PTH 655. He had one episode of bacteremia that was successfully treated with antibiotics. The patient continues to dialyze at home and is closely cared for by the home hemodialysis team and the LVAD team.

Conclusion

Hemodialysis in LVAD patients has been reported in center-based dialysis setting. However, due to several logistic challenges including training and familiarity of dialysis center staff to care for these patients, there are only a handful of hemodialysis centers that are able to accept patients with LVAD. Home hemodialysis in LVAD patients is feasible and overcomes these challenges of in-center dialysis. Very close communication and coordination between the LVAD team and HHD team is crucial.