Trends, Outcomes and Readmissions among Left Ventricular Assist Device Recipients with Acute Kidney Injury Requiring Hemodialysis: An Insight from the National Readmissions Database 2012-2014

Abstract

Purpose Although renal function may improve after left ventricular assist devices (LVAD) implantation, acute kidney injury (AKI) requiring hemodialysis (HD) therapy can occur post-operatively. We sought to investigate in-hospital outcomes and readmissions among patients who developed AKI requiring HD during index admission for LVAD implantation. Methods We utilized data from the National Readmissions Database and the US Census Bureau to calculate annual national rates of in-hospital mortality, stroke, post-operative bleeding, length of stay, hospital cost and readmissions among patients who underwent implantation and developed acute kidney injury(AKI) requiring hemodialysis (HD) for years 2012 to 2014. Results We identified 208 patients with AKI on HD after LVAD implantation (weighted\u2009=\u2009536). Among these patients, 68.5% had chronic kidney disease and 45.8% diabetes before LVAD implantation. Rates of in-hospital mortality (from 55.53% in 2012 to 34.67 % in 2014, p=0.025), length of stay (from 66.8 days in 2012 to 52.1 days in 2014, p Conclusion In-hospital mortality and length of stay are decreasing in patients requiring HD for AKI after LVAD implantation but remain higher than LVAD recipients without AKI on HD. A significant percentage of these patients who survive hospital discharge require maintenance hemodialysis.