Breaking News
October 19, 2018 - Beckman Coulter Life Sciences announces new research-focused website
October 19, 2018 - Study finds link between refined soluble fibers, gut microbiota and liver cancer
October 19, 2018 - Social media reduces risk of depression among seniors with pain
October 19, 2018 - Newly developed synthetic DNA molecule may one day be used as ‘vaccine’ for prostate cancer
October 19, 2018 - Preoperative weight loss may not provide health benefits after surgery
October 19, 2018 - U.S. Birth Rates Continue to Drop as Age of New Moms Rises
October 19, 2018 - New technology can keep an eye on babies’ movements in the womb
October 19, 2018 - Juul e-cigarettes pose addiction risk for young users | News Center
October 19, 2018 - Gene sequencing reveals crucial molecular aspects of Trypanosoma brucei
October 19, 2018 - New DNA vaccine strategy protects mice against lethal challenge by multiple H3N2 viruses
October 19, 2018 - Study shows close link between cytokine interleukin-1ß and obesity-promoted colon cancer
October 19, 2018 - Muscle mass plays a critical role in health, shows research
October 19, 2018 - Study finds undiagnosed prediabetes in many infertile men
October 19, 2018 - The Current issue of “The view from here” is concerned with Nanotherapeutic strategies
October 19, 2018 - Delay in replacing the Pap smear with HPV screening is costing lives
October 19, 2018 - Physicians battle pediatric diseases of ear, nose, throat in Zimbabwe | News Center
October 19, 2018 - Researchers investigate why some cancers affect only young women
October 19, 2018 - Drugmakers funnel millions to lawmakers; a few dozen get $100,000-plus
October 19, 2018 - Unselfish people tend to have more children and receive higher salaries
October 19, 2018 - New findings reveal potential cellular players in tumor microenvironment
October 19, 2018 - Human brain cell transplant offers insights into neurological conditions
October 19, 2018 - Parental education associated with increased family health care spending
October 19, 2018 - New statistical method estimates long- and short-term risk of recurrence of breast cancer in US women
October 19, 2018 - Father’s exposure to nicotine may cause cognitive deficits in descendants
October 19, 2018 - Could we prevent Alzheimer’s disease by treating herpes?
October 19, 2018 - Nurse-led care can be more successful in managing gout
October 19, 2018 - Trump administration, pharma exchange verbal volleys on drug-price transparency
October 19, 2018 - Duke researchers find way to detect blood doping in athletes
October 19, 2018 - Many primary care doctors are still prescribing sedative drugs for older adults
October 19, 2018 - Finger length can predict sexuality in women say researchers
October 19, 2018 - Study finds differences in side-effects experienced by male and female OG cancer patients
October 19, 2018 - Few Seniors Who Self-Harm Referred for Mental Health Care
October 19, 2018 - Don’t sweat the sweet stuff
October 19, 2018 - URMC researchers discover new approach to deliver therapeutics to the brain
October 19, 2018 - Middlemen suppliers can increase drug prices and hospital bills, say Johns Hopkins researchers
October 19, 2018 - Bliss funds research to find whether parental touch can help alleviate pain in premature infants
October 19, 2018 - Human neurons employ highly compartmentalized signaling, study shows
October 19, 2018 - Ultromics expands multiple clinical trials for coronary heart disease to the U.S.
October 19, 2018 - $11 million NIH grant for Clemson University helps launch new center for musculoskeletal research
October 19, 2018 - A new approach identified to control Zika virus, dengue fever
October 19, 2018 - Head Blows Without Concussion May Not Damage Brain, Study Claims
October 19, 2018 - US opioid use not declined, despite focus on abuse and awareness of risk
October 19, 2018 - Next-generation RNA sequencing technology sheds new light on human mitochondrial diseases
October 19, 2018 - UT Southwestern biochemist receives 2019 Breakthrough Prize in Life Sciences for innate immunity discovery
October 19, 2018 - The immune system also plays a key role in day-to-day function of healthy organs
October 19, 2018 - New tool may reveal how the brain structure impacts brain activity, human behavior
October 19, 2018 - Trump Administration announces ‘Winning on Reducing Food Waste’ initiative
October 19, 2018 - For-profit nursing home residents more likely to experience health issues caused by substandard care
October 19, 2018 - Incidence of stroke has risen steadily among marijuana users, show studies
October 19, 2018 - Conceptual framework proposed to examine role of exercise in multiple sclerosis
October 19, 2018 - Near infrared spectroscopy technique for accurate evaluation of chondral injuries
October 19, 2018 - Scientists receive $5.1 million grant to develop stem cell-based therapy for blinding retinal conditions
October 19, 2018 - Shorter physician encounters associated with antibiotic prescribing
October 19, 2018 - In the Spotlight: Enjoying research and exploring opportunities
October 19, 2018 - Physical activity lowers cardiovascular mortality risk in frail older adults
October 19, 2018 - New imaging tool helps visualize how sound-induced vibrations travel through the ear
October 19, 2018 - Key insights into the application, production of bioactive materials
October 19, 2018 - New urea sorbent could speed up the development of wearable artificial kidney
October 19, 2018 - Intensive care patients’ muscles less able to use fats for energy
October 19, 2018 - FDA Advisory Committee Recommends Approval of Dsuvia for the Treatment of Moderate-to-Severe Acute Pain
October 19, 2018 - 48,XXXY syndrome – Genetics Home Reference
October 19, 2018 - Physical exercise improves the elimination of toxic proteins from muscles
October 19, 2018 - How a new system improved wait times for Stanford kidney transplant patients
October 19, 2018 - Nutrition has bigger positive impact on bone mass and strength than exercise
October 19, 2018 - Study finds lack of progress in media representation of nurses over last 20 years
October 19, 2018 - Many people have trouble understanding differences between OCD and OCPD
October 19, 2018 - New family planning app found to be as effective as modern methods
October 19, 2018 - Gastric Banding, Metformin Similar for Improving Glycemia
October 19, 2018 - Physiologist publishes findings on the role of the protein titin in muscle contraction
October 19, 2018 - What digital health companies need to do to succeed
October 19, 2018 - N. Carolina Sees Alarming Spike in Heart Infections Among Opioid Users
October 19, 2018 - Video monitoring of TB therapy works well in urban and rural areas
October 19, 2018 - Determining acid-neutralizing capacity for OTC antacids
October 19, 2018 - Males who spend more time taking care of kids have greater reproductive success
October 18, 2018 - Study to explore bioethics of brain organoids
October 18, 2018 - Environmental conditions may drive development of multiple sclerosis
October 18, 2018 - Genetically modifying zebrafish provides more accurate disease models
October 18, 2018 - Purdue Pharma, Eisai announce positive topline results from Phase 3 study of lemborexant
October 18, 2018 - 5 Strength-Training Mistakes to Avoid
October 18, 2018 - Immune system’s balancing act keeps bowel disease in check
ESRD Tied to ‘Exceptionally High’ Mortality Rates After LVAD Placement

ESRD Tied to ‘Exceptionally High’ Mortality Rates After LVAD Placement

image_pdfDownload PDFimage_print

Action Points

  • Patients with end-stage renal disease (ESRD) have an especially poor prognosis if they decide to get a left ventricular assist device (LVAD) for their advanced heart failure.
  • The study suggests that ESRD patients should ideally be informed about the very poor prognosis of most patients with ESRD who receive an LVAD.

Patients with end-stage renal disease (ESRD) have an especially poor prognosis if they decide to get a left ventricular assist device (LVAD) for their advanced heart failure, a small study suggested.

By a median of 762 days since LVAD placement — whether as bridge to heart transplant or destination therapy — 81.9% and 36.4% of ESRD and non-ESRD patients had died, respectively. During the index hospitalization, the odds of death in the two patient groups were 51.6% and 4%, according to Nisha Bansal, MD, MAS, of the University of Washington’s Kidney Research Institute in Seattle, and colleagues.

Even after accounting for factors like demographics and comorbidity, ESRD patients had a markedly higher risk of mortality (adjusted HR 36.3, 95% CI 15.6 to 84.5), with the survival gap widest between groups in the first 60 days (when 72.4% and 6.3% had died), the study published online in JAMA Internal Medicine showed.

“Patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks,” Bansal and colleagues concluded. “The median survival of 16 days after LVAD placement and high in-hospital mortality for patients with ESRD in this study suggests that these procedures are either being offered at a time when patients are actively dying or that they actually precipitate this process.”

Subjects in the study were Medicare beneficiaries with ESRD (those included in the U.S. Renal Data System registry for having received maintenance dialysis or a kidney transplant; n=155) compared with a 5% sample of peers without the condition (n=261).

Of the entire ESRD group, just 2.9% went on to have a heart transplant and were alive 1 year after LVAD placement.

In an accompanying invited commentary, Sunu Thomas, MD, MSc, of Massachusetts General Hospital in Boston, and colleagues, wrote: “There continues to be a variable practice in mechanical circulatory support utilization among marginal LVAD candidates with end-stage heart failure. We commend the authors for providing further corroborative data in support of current guidelines discouraging LVAD therapy in patients with ESRD.”

Notably, however, according to the commentary, it appeared that more and more patients with ESRD were getting LVADs over time: 0.32 per 10,000 person-years in the 2003-2006 period versus 0.45 per 10,000 in 2010-2013. “The seemingly indiscriminate use of implantable LVADs” may be due to the researchers’ reliance on ICD-9 coding to identify the study cohort — which may have thrown temporary and permanent circulatory support device use into the same mix, Thomas et al wrote.

“The current analysis warrants further elaboration to explain the exceptionally high mortality rate and the appropriateness of LVAD therapy in a recognized marginal mechanical circulatory support candidate population. Paramount among our concerns is the database from which the analysis is derived.”

The commentary also cited the study’s lack of details such as cause of death and concomitant use of acute circulatory support.

Bansal and colleagues acknowledged that their retrospective study was without granular data. In addition, they were not able to perform any subgroup analyses within the ESRD cohort due to the small sample size.

Baseline imbalances between groups were quite common, too: the ESRD group was slightly younger and counted fewer men, and had more black patients with a greater burden of comorbidity as well.

“A strength of our analysis is that we describe outcomes after LVAD placement among nationally representative cohorts,” the team wrote. “Unlike prior studies of outcomes among LVAD recipients with kidney failure, which we suspect have included mainly patients receiving acute dialysis, we studied Medicare beneficiaries with ESRD. Our results may help to inform treatment decisions in patients with ESRD and heart failure who are contemplating LVAD placement. These patients should ideally be informed about the very poor prognosis of most patients with ESRD who receive an LVAD.”

Bansal and colleagues reported no conflicts of interest.

Thomas and co-authors disclosed no conflicts of interest.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

1969-12-31T19:00:00-0500

last updated

Tagged with:

About author

Related Articles