Renal Failure in Patients with Left Ventricular Assist Devices

Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction befor...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2013-03, Vol.8 (3), p.484-496
Main Authors: Patel, Ami M, Adeseun, Gbemisola A, Ahmed, Irfan, Mitter, Nanhi, Rame, J Eduardo, Rudnick, Michael R
Format: Article
Language:English
Subjects:
Acute Kidney Injury - etiology
Acute Kidney Injury - physiopathology
Acute Kidney Injury - therapy
Heart Failure - complications
Heart Failure - mortality
Heart Failure - physiopathology
Heart Failure - therapy
Heart-Assist Devices - adverse effects
Hemodynamics
Humans
Kidney - physiopathology
Prosthesis Design
Recovery of Function
Renal Dialysis
Renal Insufficiency - complications
Renal Insufficiency - mortality
Renal Insufficiency - physiopathology
Renal Insufficiency - therapy
Treatment Outcome
Ventricular Function, Left
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Summary:Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require long-term outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.06210612