Peritoneal Dialysis in Patients Supported by Left Ventricular Assist Device

Introduction

Terminal heart failure is often associated with end-stage kidney disease. Due to advantages concerning patient independence, peritoneal dialysis (PD) is an alternative to conventional hemodialysis treatment. As left ventricular assist device implantations continuously increase, data on combined PD and LVAD is rare. We present the first and largest cohort study on this exclusive patient cohort.

Methods

A retrospective study was conducted on patients who underwent LVAD implantation at a high-volume heart failure center from 2000 to 2024. Adverse events were analyzed according to the INTERMACS classification.

Results

A total of nine patients were identified as undergoing PD on LVAD therapy. Mean age at the time of LVAD implantation was 67 years. Main cause of kidney disease was cardio-renal syndrome (67%). In all patients, PD therapy was established before LVAD implantation. Mean time on PD before LVAD implantation was 72 months. None of the patients were weaned from dialysis nor were converted to conventional dialysis. Four patients experienced driveline infection. Three patients suffered an infection of their PD catheter. A combination of PD and DL infection was detected in two cases. None of these infections were associated with the same pathogens. Mean survival after LVAD + PD was 56.5 months.

Conclusion

Peritoneal dialysis has advantages over hemodialysis including fewer bloodstream infections, fewer hemodynamic shifts, and the comfort of the ambulant setting. This study illustrates that PD in LVAD patients is feasible and long-term support up to several years is achievable without major complications.