Overcoming obstacles: Patients with Ventricular Assist Devices (VADs) in dialysis setting

Ms Tina Chang¹, Ms Cindy Zhao²

¹St. Vincent’s Hospital, Sydney, Sydney, Australia, ²St.Vincent’s Hospital, Sydney, Sydney, Australia

Biography:

Passionate dialysis nurses

Abstract:

Introduction/Background

Left ventricular assist devices (LVAD), used as bridge-to-transplant and destination therapy in patients with heart failure, impact not only cardiac function but also renal function, especially in patients with pre-existing renal dysfunction.

AKI is one of the most common and anticipated complications in the early postoperative period following LVAD implantation.

Case Description:

Between 2024 and 2025, 12 patients with LVADs requiring intermittent haemodialysis were managed at St. Vincent’s Hospital, Sydney. Among these, 10 recovered from AKI (two received a cardiac transplant and eight are awaiting transplant), while two patients withdrew treatment and died.

During their stay in the dialysis unit, these patients experienced common complications such as infectious issues, hypervolemia, unpredictable blood pressure fluctuations, and neurological events.

Discussion:

Patients with LVADs stepping down from the intensive care unit (ICU) to general inpatient settings require highly specialized management for intermittent haemodialysis.

Because LVAD patients have non-pulsatile blood flow, ultrasound Doppler measurements are used. In addition to monitoring differences, resuscitation protocols differ: standard CPR may dislodge the device, causing more harm than good.

Multidisciplinary Coordination is required, including:

1. Haemodynamic and blood pressure monitoring: using Doppler measurement and setting target MAP.
2. Vascular Access Management
3. Monitoring Renal Function
4. Safety and emergency protocols
5. Equipment and environment

Conclusion:

Intermittent haemodialysis continues to be the standard of care for LVAD patients requiring renal replacement therapy.  As such, multidisciplinary coordination and staff accreditation are critical pillars for delivering high-quality, safe treatment, resulting in reduced adverse events and improved patient outcomes.