Impact of Chronic Kidney Disease Stage on In-Hospital Bleeding and Mortality in Percutaneous Left Ventricular Assist...

Bleeding events have been reported as a complication of percutaneous left ventricular assist devices (pLVAD). While chronic kidney disease (CKD) independently increases bleeding risk, the impact of worsening CKD stages on bleeding outcomes following pLVAD implantation remains poorly characterized. Therefore, we sought to evaluate the impact of CKD severity gradient on major bleeding and in-hospital mortality among adults undergoing pLVAD implantation. The National Inpatient Sample was queried from 2016 to 2021. Adults undergoing pLVAD implantation were stratified into 6 cohorts: no CKD, CKD stages 1 to 2, stage 3, stage 4, stage 5, and end-stage renal disease (ESRD). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) of major bleeding, in-hospital mortality, and secondary outcomes. A cohort of 130,620 pLVAD hospitalizations was identified, of which 72.9% had no CKD, 2.0% had CKD stages 1 to 2, 14.1% had CKD stage 3, 3.0% had CKD stage 4, 0.4% had CKD stage 5, and 7.6% had ESRD. Following adjustment, CKD stages 1 to 5 showed no significant association with major bleeding. In contrast, ESRD was independently associated with increased odds of mortality (aOR 1.25; 95% CI 1.63-2.25, p <0.001), major bleeding (aOR, 1.45; 95% CI 1.23-1.65; p <0.001) and specific bleeding types including gastrointestinal bleeding (aOR 1.92; 95% CI 1.63-2.25) and intra-abdominal bleeding (aOR 1.81; 95% CI 1.18-2.78). In conclusion, ESRD represents a high-risk phenotype characterized by significantly increased major bleeding and in-hospital mortality. Major bleeding is driven by site-specific hemorrhage, including gastrointestinal, intra-abdominal, and pericardial bleeding. Risk stratification and targeted anticoagulation strategies are necessary for this vulnerable population.