[Skip to Content]
[Skip to Content Landing]
Original Investigation
February 2018

Outcomes Associated With Left Ventricular Assist Devices Among Recipients With and Without End-stage Renal Disease

Author Affiliations
  • 1University of Washington, Division of Nephrology, Kidney Research Institute, Seattle
  • 2Division of Nephrology, Stanford University, Palo Alto, California
  • 3Veterans Affairs Palo Alto Health Care System, Palo Alto, California
  • 4Kaiser Permanente Washington Research Institute, Seattle, Washington
  • 5Veterans Affairs Puget Sound Health Care System, Seattle, Washington
JAMA Intern Med. 2018;178(2):204-209. doi:10.1001/jamainternmed.2017.4831
Key Points

Question  Do outcomes after placement of a left ventricular assist device (LVAD) for the treatment of advanced heart failure in patients with end-stage renal disease (ESRD) differ compared with those of patients without ESRD?

Findings  In this 11-year study of a nationally representative patient population of LVAD recipients, 81.9% of patients with ESRD prior to LVAD implantation died during follow-up (vs 36.4% among patients without ESRD) and the median time to death was 16 days after LVAD placement for patients with ESRD (vs 2125 days for those without ESRD).

Meaning  Left ventricular assist device recipients with preexisting ESRD have an extremely poor prognosis.


Importance  Left ventricular assist devices (LVADs) are widely used both as a bridge to heart transplant and as destination therapy in advanced heart failure. Although heart failure is common in patients with end-stage renal disease (ESRD), little is known about outcomes after LVAD implantation in this population.

Objective  To determine the utilization of and outcomes associated with LVADs in nationally representative cohorts of patients with and without ESRD.

Design, Setting and Participants  We described LVAD utilization and outcomes among Medicare beneficiaries after ESRD onset (defined as having received maintenance dialysis or a kidney transplant) from 2003 to 2013 based on Medicare claims linked to data from the United States Renal Data System (USRDS), a national registry for ESRD. We compared Medicare beneficiaries with ESRD to a 5% sample of Medicare beneficiaries without ESRD.

Exposures  ESRD (vs no ESRD) among patients who underwent LVAD placement.

Main Outcomes and Measures  The primary outcome was survival after LVAD placement.

Results  Among the patients with ESRD, the mean age was 58.4 (12.1) years and 62.0% (96) were male. Among those without ESRD, the mean age was 62.2 (12.6) years and 75.1% (196) were male. From 2003 to 2013, 155 Medicare beneficiaries with ESRD (median and interquartile range [IQR] days from ESRD onset to LVAD placement were 1655 days [453-3050 days]) and 261 beneficiaries without ESRD in the Medicare 5% sample received an LVAD. During a median follow-up of 762 days (IQR, 92-3850 days), 127 patients (81.9%) with and 95 (36.4%) without ESRD died. more than half of patients with ESRD (80 [51.6%]) compared with 11 (4%) of those without ESRD died during the index hospitalization. The median time to death was 16 days (IQR 2-447 days) for patients with ESRD compared with 2125 days (IQR, 565-3850 days) for those without ESRD. With adjustment for demographics, comorbidity and time period, patients with ESRD had a markedly increased adjusted risk of death (hazard ratio, 36.3; 95% CI, 15.6-84.5), especially in the first 60 days after LVAD placement.

Conclusions and Relevance  Patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks. This information may be crucial in supporting shared decision-making around treatments for advanced heart failure for patients with ESRD.