title: Renal dysfunction and chronic mechanical circulatory support: from patient selection to long-term management and prognosis.
abstract: OBJECTIVE
  The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with an additional focus on the evaluation and management of both preimplant and post-MCS renal dysfunction.
  
  
  RESULTS
  Renal dysfunction is highly prevalent in patients referred for MCS and is associated with significantly increased mortality and postoperative acute kidney injury. Most patients, including those with renal dysfunction, experience marked early improvement in renal function with MCS, likely secondary to correction of the cardiogenic shock, volume overload, and neurohormonal activation characteristic of advanced heart failure. Currently, there are no diagnostic tests to definitively distinguish reversible forms of renal dysfunction likely to improve with MCS from irreversible renal dysfunction. Furthermore, the characteristic improvements in renal function observed in the early months of MCS are often transient, with subsequent recurrence of renal dysfunction with longer durations of support. Venous congestion, right ventricular dysfunction, and reduced pulsatility are potential mechanisms involved in resurgence of renal dysfunction following MCS.
  
  
  CONCLUSIONS
  With the exponential growth of MCS, research endeavors to both improve understanding of the mechanisms behind observed changes in renal function and elucidate the device-related effects on the kidney are imperative.
authors.affiliation: aDepartment of Medicine, Cardiovascular Division, Medical University of South Carolina, Charleston, South Carolina bProgram of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut cDepartment of Medicine, Cardiovascular Division, University of Arizona, Tucson, Arizona, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Brisco
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cook
mesh_terms: D001243:Assisted Circulation; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D018579:Patient Selection; D011379:Prognosis; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy