Department of Medicine, Stanford University, Palo Alto, CA; Veteran Affairs Palo Alto Health Care System, Palo Alto, CA.
Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA.
Am J Kidney Dis. 2021 Feb;77(2):226-234. doi: 10.1053/j.ajkd.2020.04.018. Epub 2020 Jul 23.
RATIONALE & OBJECTIVE: The incidence of left ventricular assist device (LVAD) implantation as destination therapy for heart failure is increasing and kidney failure requiring maintenance hemodialysis is a common complication. Because little is known about the safety or efficacy of outpatient hemodialysis among patients with LVADs, this study sought to describe their clinical course.
Case series of patients with an LVAD undergoing maintenance outpatient hemodialysis whose clinical data were obtained from an electronic medical record.
SETTING & PARTICIPANTS: Adults who received an LVAD, survived to hospital discharge, and were subsequently treated with maintenance hemodialysis by a not-for-profit dialysis provider between 2011 and 2019.
11 patients were included. 6 had a known history of chronic kidney disease. Patients underwent outpatient hemodialysis for a mean duration of 165.2 (range, 31-542) days, during which they were treated with 544 total dialysis sessions. 6 of these sessions were stopped early due to dialysis-related adverse events (1.1%). More than 80% of follow-up time was spent out of the hospital; however, 55% of patients were rehospitalized within 1 month of starting outpatient hemodialysis. The most common reason for hospitalization was infection (32%), followed by hypervolemia (14%), and cerebrovascular accident or transient ischemic attack (11%). 4 patients recovered kidney function, 1 underwent combined heart and kidney transplantation, 2 continued treatment, 2 died, and 2 were lost to follow-up.
Retrospective design, small number of cases, and lack of complete follow-up data.
Approximately half the patients with complete follow-up either recovered kidney function or underwent combined heart and kidney transplantation. This case series demonstrates that outpatient hemodialysis centers, in partnership with LVAD treatment teams, can successfully provide hemodialysis to patients on LVAD support.
作为心力衰竭的终末期治疗手段，左心室辅助装置（LVAD）的植入率不断上升，肾衰竭需要维持性血液透析是常见的并发症。由于 LVAD 患者门诊血液透析的安全性和疗效知之甚少，本研究旨在描述其临床过程。
对在电子病历中接受 LVAD 治疗、存活至出院后并随后由非营利性透析提供者进行维持性门诊血液透析的患者进行病例系列研究。
2011 年至 2019 年期间，接受 LVAD 治疗、存活至出院且随后由非营利性透析提供者进行维持性门诊血液透析的成年人。
共纳入 11 例患者，其中 6 例有明确的慢性肾脏病病史。患者接受门诊血液透析的平均持续时间为 165.2（范围 31-542）天，共进行了 544 次透析治疗。其中 6 次因透析相关不良事件（1.1%）提前停止。超过 80%的随访时间在院外进行，但有 55%的患者在开始门诊血液透析后 1 个月内再次住院。住院的最常见原因是感染（32%），其次是血容量过多（14%）和脑血管意外或短暂性脑缺血发作（11%）。4 例患者恢复了肾功能，1 例接受了心脏和肾脏联合移植，2 例继续治疗，2 例死亡，2 例失访。
回顾性设计、病例数量少且缺乏完整的随访数据。
大约一半的患者在完成随访后，要么恢复了肾功能，要么接受了心脏和肾脏联合移植。该病例系列研究表明，门诊血液透析中心与 LVAD 治疗团队合作，可以成功地为接受 LVAD 支持的患者提供血液透析治疗。
