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Impact of Chronic Kidney Disease Stage on In-Hospital Bleeding and Mortality in Percutaneous Left Ventricular Assist Device Recipients: A Nationwide Perspective.

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Title: Impact of Chronic Kidney Disease Stage on In-Hospital Bleeding and Mortality in Percutaneous Left Ventricular Assist Device Recipients: A Nationwide Perspective.
Authors: Vasquez Ariza S; Department of Medicine, Universidad del Norte, Barranquilla, Colombia. Electronic address: sebvasar@gmail.com., Pedrosa DEDT; Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida., Diaz PO Jr; Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida., Jumkhawala S; Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida., Colombo R; Department of Cardiology, Jackson Memorial Hospital, Miami, Florida., Munagala M; Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
Source: The American journal of cardiology [Am J Cardiol] 2026 Oct 01; Vol. 276, pp. 86-92. Date of Electronic Publication: 2026 Aug 02.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0207277 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1913 (Electronic) Linking ISSN: 00029149 NLM ISO Abbreviation: Am J Cardiol Subsets: MEDLINE
Imprint Name(s): Original Publication: New York, NY : Excerpta Medica
MeSH Terms: Heart-Assist Devices*/adverse effects , Renal Insufficiency, Chronic*/complications , Postoperative Hemorrhage*/epidemiology , Heart Failure*/therapy , Heart Failure*/complications , Hemorrhage*/epidemiology, United States/epidemiology ; Kidney Failure, Chronic/complications ; Gastrointestinal Hemorrhage/epidemiology ; Humans ; Female ; Hospital Mortality ; Male ; Middle Aged ; Aged ; Risk Factors ; Severity of Illness Index ; Retrospective Studies
Abstract: 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.
(Copyright © 2026 Elsevier Inc. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: chronic kidney disease; gastrointestinal bleeding; in-hospital mortality; major bleeding; percutaneous left ventricular assist device
Entry Date(s): Date Created: 20260802 Date Completed: 20260912 Latest Revision: 20260912
Update Code: 20260913
DOI: 10.1016/j.amjcard.2026.07.035
PMID: 42543098
Database: MEDLINE
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  Data: Impact of Chronic Kidney Disease Stage on In-Hospital Bleeding and Mortality in Percutaneous Left Ventricular Assist Device Recipients: A Nationwide Perspective.
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  Data: 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 &amp;lt;0.001), major bleeding (aOR, 1.45; 95% CI 1.23-1.65; p &amp;lt;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.&lt;br /&gt; (Copyright &#169; 2026 Elsevier Inc. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;chronic kidney disease; gastrointestinal bleeding; in-hospital mortality; major bleeding; percutaneous left ventricular assist device
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        Value: 10.1016/j.amjcard.2026.07.035
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        Text: English
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      – SubjectFull: United States epidemiology
        Type: general
      – SubjectFull: Kidney Failure, Chronic complications
        Type: general
      – SubjectFull: Gastrointestinal Hemorrhage epidemiology
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      – TitleFull: Impact of Chronic Kidney Disease Stage on In-Hospital Bleeding and Mortality in Percutaneous Left Ventricular Assist Device Recipients: A Nationwide Perspective.
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