PERITONEAL DIALYSIS WITH LEFT VENTRICULAR ASSIST DEVICE: A CASE STUDY
Dr Andrea Huang1,3, Dr Jolene Ng1,3, Sister Monica Bexton3, Sister Lisa Paquin3, Dr Namrata Khanal3, Dr Jeffrey Wong1, Professor Jacob Sevastos2,3, Dr James Tang2,3
1Liverpool Hospital, Sydney, Australia, 2Notre Dame University, Sydney, Australia, 3St Vincent’s Hospital, Sydney, Australia
Background: For patients with severe cardiomyopathy and advanced heart failure who are awaiting cardiac transplants it is relatively common to have a Left Ventricular Assist Device (LVAD) inserted as a bridge-to-transplant therapy. Traditionally peritoneal dialysis (PD) is relatively contraindicated in LVADs due to driveline locations within the peritoneum thereby conferring an increased risk of infection. Here we discuss a patient who was continued on PD whilst being on Extracorporeal Membrane Oxygenation (ECMO) and LVAD.
Case Report: A 33-year-old man presented initially for presumed systemic lupus erythematosus (SLE) related myocarditis complicated by cardiogenic shock with known SLE. Prior to his admission he had been peritoneal dialysis-dependent for the past 12 months with end stage renal failure secondary to lupus nephritis.
He was first started on ECMO. A temporary implantable cardiac defibrillator (ICD) was then inserted for overdrive pacing and defibrillation before an LVAD was ultimately inserted.
During this time, he had transitioned off continuous renal replacement therapy and continued on PD with continuous titration of his PD prescription. He ultimately passed away from LVAD driveline-related candidaemia with negative PD cultures throughout admission.
Conclusions: For LVAD patients with end stage renal failure PD is a reasonable option for renal replacement therapy. There have been concerns with an increased risk of infection with the aforementioned combination; whilst the driveline was infected in this case this was unlikely related to PD. There are advantages in pursuing peritoneal over haemodialysis; in this particular case minimal impact on his unstable haemodynamics was a major factor.
Biography:
Dr. Andrea Huang is a final year renal advanced trainee in the Central-Southwestern-Regional network of New South Wales. She has a special interest in transplant, glomerulonephrites, and application of statistics to research.