Tolerability of Intermittent Hemodialysis in a Cohort of Patients with Left Ventricular Assist Device

Background The use of left ventricular assist device (LVAD) has emerged as a popular treatment for patients with advanced heart failure. It is not uncommon for these patients to suffer from renal failure requiring renal replacement therapy. The purpose of this study is to assess hemodynamic parameters and ability to complete the prescribed hemodialysis session in a series of patients who underwent numerous dialysis treatments. Methods Nine patients with Heart Mate II LVAD received 170 intermittent inpatient hemodialysis treatments between January 1, 2010 and December 31, 2012. Assessment included vital signs, ultrafiltrate removed, hemodialysis duration, symptoms, early terminations (ET), and adverse events during each hemodialysis session. Results The mean age was 53 ± 18 with a range of 26-83 years, with a male predominance (7/9). Indication for LVAD was as destination therapy (DT) in the majority of patients (6/9). Nine patients who received a total of 170 hemodialysis sessions with a mean prescribed and achieved: ultrafiltration (liters) 1.98 ± 1.5 and 1.90 ± 1.6; hemodialysis duration (hours) 3.12 ± 0.3 and 2.86 ± 0.9, respectively. Early termination was experienced in 11 sessions (6.5%). Causes of ET were hypotension in 72.7%, other causes were equally distributed between clotted extra-corporeal circuits, nausea & vomiting and LVAD alarm (9.1% in each). Serious arrhythmias were not observed in any of the hemodialysis treatments. Six out of nine patients (66.7%) recovered kidney function and became dialysis independent. Conclusion In a hospital setting, patients with LVAD can often tolerate and complete the prescribed hemodialysis treatment.