Tuesday, December 19, 2017

In the NEWS: LVADs and ESRD

Should patients on dialysis or kidney transplant be offered LVADS for severe CHF?
A new study just published in JAMA internal Medicine showed that patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks.

This was a observational analysis of the USRDS data of all patients on ESRD that received an LVAD.  155 Medicare beneficiaries with ESRD (median and interquartile range [IQR] days from ESRD onset to LVAD placement were 1655 days [453-3050 days]) and 261 beneficiaries without ESRD in the Medicare 5% sample received an LVAD. During a median follow-up of 762 days, 127 patients (81.9%) with and 95 (36.4%) without ESRD died. More than half of patients with ESRD (80 [51.6%]) compared with 11 (4%) of those without ESRD died during the index hospitalization. The median time to death was 16 days for patients with ESRD compared with 2125 days for those without ESRD. Most of these patients were hemodialysis with a small minority being PD and transplantation. So, unclear what the data is for PD vs transplantation.

In addition, what would have happened if the patients continued conservative management and not offered LVAD- would their outcomes have been similar or better? This really brings the question on whether LVADS should be offered to ESRD patients on dialysis.

Two recent reviews in AJKD and CJASN discuss the role of the Nephrologist and the Kidney in patients with LVADs.

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