Abstract: FR-PO656
Adverse Events During Hemodialysis in HeartWare LVAD Recipients
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Author
- Stalam, Tapati, University of Maryland Medical Center, BALTIMORE, Maryland, United States
Introduction
Over the past decade, implantable left ventricular assist devices have become an acceptable alternative to support patients with advanced heart failure, either as a bridge to transplantation or as destination therapy for patients who are not candidates for heart transplantation. As the number of LVAD implantation increases, greater number of LVAD recipients requiring long term renal replacement therapy, usually chronic hemodialysis (HD), will be seen. This is due to common simultaneous chronic kidney disease in patients with heart failure, but more frequently due to irreversible acute kidney injury occurring in the peri-implantation period. We looked at 92 HD sessions in HeartWare LVAD recipients between 2015 and 2017 and assessed adverse events requiring early termination of HD sessions.
Case Description
Between 2015 and 2017 at the University of Maryland Medical Center, 7 patients required HD after LVAD implantation. These 7 patients had a total of 92 HD sessions during their hospitalizations. The average age of the patients was 46 +/- 11.9 years old. Two patients had ESRD and were on HD prior to LVAD implantation. The remaining 5 patients had CKD but were not on HD. The pre-LVAD creatinine average for all 7 patients was 2.55 +/- 1.8. After LVAD implantation, all of the patients were initially on continuous renal replacement therapy before being transitioned to HD. During HD all patients were on midodrine, vasopressors, or fludrocortisone to help increase blood pressure. There were 7 HD sessions that required early termination due to symptomatic hypotension (3), asymptomatic hypotension (2), sinus tachycardia and cramping and discomfort. The average duration of all HD sessions was 172 minutes and the average duration of HD sessions that were terminated early was 148 minutes.
Discussion
7 out of 92 sessions required early termination and the most common reasons (5 out of 7) were related to hypotension. Complications related to blood pressure was also found to be the most common reason for termination of HD in a previous study of HD sessions in Heartmate LVAD patients. As a result of continuous-flow technology, in most LVAD recipients, there is an absence of pulse, precluding the standard assessment of blood pressure and making assessment of blood pressure during dialysis difficult. There needs to be more research on how to address this in addition to how to optimize and change LVAD settings during HD sessions.