Dialysis-Requiring Renal Failure at the Time of HeartMate 3 Left Ventricular Assist Device Implantation

Dialysis-requiring renal failure at left ventricular assist device (LVAD) implantation represents a critical clinical phenotype. We retrospectively analyzed 235 adults undergoing HeartMate 3 implantation at a single tertiary center (2016-2025), comparing 27 dialysis-dependent patients with 208 non-dialysis recipients. Dialysis patients exhibited markedly higher preoperative acuity, including more frequent pre-implant extracorporeal membrane oxygenation (ECMO) support (59.3% vs. 20.2%; p < 0.001) and lower Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scores (median 1.0 vs. 3.0; p < 0.001). Postoperatively, dialysis patients had significantly higher tracheostomy rates (51.9% vs. 18.8%; p < 0.001), prolonged mechanical ventilation (386 vs. 21 hours; p < 0.001), and longer intensive care unit (ICU) stays (455 vs. 118 hours; p < 0.001). Hospital mortality was significantly higher in the dialysis group (33.3% vs. 12.5%; p = 0.009). One-year survival was 55.6% vs. 79.8% (p = 0.013), and 2 year survival was 55.6% vs. 75.5% (p = 0.037). On multivariable analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.09; p < 0.001) and INTERMACS score were independent mortality predictors, whereas dialysis status was not independently associated after adjustment. Pre-implant ECMO was the strongest tracheostomy predictor (OR: 3.65; 95% CI: 1.65-8.28; p = 0.001). Dialysis-requiring renal failure at HM3 implantation identifies a high-risk population with significantly worse outcomes, driven primarily by preoperative hemodynamic severity rather than renal failure itself.