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 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.
Nephrology Division, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA. ami.patel@drexelmed.edu
Ami M
AM
Patel
Gbemisola A
GA
Adeseun
Irfan
I
Ahmed
Nanhi
N
Mitter
J Eduardo
JE
Rame
Michael R
MR
Rudnick
D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D011474:Prosthesis Design; D020127:Recovery of Function; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D016277:Ventricular Function, Left