Maintenance Haemodialysis in an LVAD Recipient in an Outpatient Community Dialysis Centre-A Case Report.

Abstract

Heart transplant remains the treatment of choice for patients with advanced heart failure (HF). However, due to a lack of donor organs, left ventricular assist devices (LVADs) have been used as a bridge until donor organs become available. Recently, we have observed more patients with advanced HF being placed on LVAD as destination therapies, particularly in patients with contraindications to heart transplantation. Acute kidney injury (AKI) post-LVAD implantation is common. Even with renal recovery, these patients are surviving longer and hence it is not uncommon for them to eventually develop chronic kidney disease (CKD), potentially progressing to end-stage kidney disease (ESKD) requiring kidney replacement therapy (KRT). There remains a paucity of published literature to guide prescription and management of LVAD recipients on long-term maintenance KRT, particularly in the community setting. Even the latest international guidelines on mechanical circulatory support (MCS) fail to provide adequate guidance for the management of such patients. We present a case of a patient who was on LVAD for 2 years prior to developing ESKD and share our experience of transitioning her from an inpatient hospital setting to the community haemodialysis centre with the help of a multi-disciplinary care team consisting of the cardiothoracic surgeon, cardiologist, nephrologist, LVAD coordinators, and the community haemodialysis centre nursing team. We aim to share the considerations in management of LVAD recipients on maintenance haemodialysis in a community dialysis centre and how we cared for such a patient. With an increasing prevalence of LVAD patients with renal impairment potentially requiring KRT, a standardised multidisciplinary team approach will be essential to ensure better care for these patients in the immediate post-operative setting and offer these patients the option of eventual discharge to the community.