Effectiveness of Pulmonary Artery Pressure Monitoring with CardioMEMS in Patients with Heart Failure on Dialysis

Background: Management of volume status in patients with ESKD is a challenge complicated further by the rising prevalence of cardiac disease and heart failure. Devices that monitor pulmonary arterial pressure (PAP) remotely, such as CardioMEMs, have been shown to reduce hospitalizations through early detection of congestion that often precedes clinical heart failure. However, its use has limited evidence in those with concurrent ESKD. We hypothesize that PAP measurement may be an effective tool in assisting clinicians to lower all-cause mortality and hospitalization rates in patients with concurrent heart failure and ESKD. Methods: Patients with a CardioMEMs inserted at two large hospitals with a concurrent diagnosis of ESKD were isolated for analysis and stratified by whether dialysis was initiated before or after device insertion. Hospital admissions for volume management at pre- and post-MEMs insertion along with length of stay (LOS) were tracked. Having no hospitalizations pre or post MEMs was counted as zero LOS. Results: 321 patients had a MEMs device inserted from 01/2015 to 12/2025. 22 were on HD with one patient receiving peritoneal dialysis. Five patients did not have sufficient data with both MEMs and HD, two received kidney transplantation, and two expired before the 1-year endpoint. The remaining 14 patients (61%) were included for final analysis, with 7 initiating renal replacement prior to MEMs insertion. Median age at MEMs insertion was 56 (IQR 51-61), while the majority were male, overweight, and had one or more preexisting comorbidities. Overall, there was a decrease in the number of hospitalizations post-MEMs insertion which is significant (p=0.034) in those who started HD first. Although not significant, there was also a reduction in the LOS (Table 1). Conclusion: The addition of cardioMEMs to patients with ESKD on renal replacement may be a useful tool in managing volume status once already on HD, although larger trials are needed to further investigate its use.