Author + information
- Navin Rajagopalan, MD⁎ ( and )
- Charles W. Hoopes, MD
- ↵⁎Gill Heart Institute, University of Kentucky, 900 South Limestone Street, Lexington, Kentucky 40536
We read with interest the paper by Hasin et al. (1), which reported improvement in renal function after left ventricular assist device (LVAD) implantation. Although the investigators demonstrated significant improvement in most patients, renal failure after LVAD implantation is associated with significant complications (2). In this study, 8 patients (10%) required long-term dialysis after LVAD—4 of whom died after implantation; the remaining 4 had prolonged hospitalizations (51 ± 17 days). Although renal failure is infrequent, it is associated with significant morbidity and mortality. For this reason, patients with advanced renal failure are typically not considered for LVAD implantation. Renal failure, even if infrequent, can significantly increase resource utilization at a time when health care expenditures are being scrutinized. Several studies have questioned the cost-effectiveness of LVAD therapy (3,4). Nevertheless, with appropriate patient selection, longer term benefits, such as improved renal function, can outweigh short-term morbidity.
Another concern is the reluctance of outpatient dialysis centers to accept LVAD patients. In our experience, this leads to prolonged length of stay and is detrimental to patient quality of life. There are limited data regarding the safety of hemodialysis in LVAD patients (5). Similar to the investigators, we supported several patients with intermittent hemodialysis until renal recovery without significant complications. Concerns among nephrologists stem from unfamiliarity with LVADs and perceived difficulties in measuring blood pressure on continuous flow support. Further data are needed to demonstrate the safety of hemodialysis and to alleviate the concerns of nephrologists.
Hasin et al. (1) observed a slight decrease in renal function at 6 months post-implantation compared with 1 month. For some patients on long-term LVAD support, eventual renal failure will result and, depending upon patient age and other comorbidities, transplantation may not be an option. Although some patients may live near their implantation centers and receive dialysis there, others will require the care of community dialysis centers. Outpatient dialysis centers must care for these patients, so they continue to experience the quality-of-life benefit seen with LVAD support.
- American College of Cardiology Foundation
- Hasin T.,
- Topilsky Y.,
- Schirger J.A.,
- et al.
- Boyle A.J.,
- Savitt M.A.,
- Sulemanjee N.Z.,
- et al.