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2015 ; 20
(4
): 519-32
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Left ventricular assist devices: a kidney s perspective
#MMPMID25796403
Tromp TR
; de Jonge N
; Joles JA
Heart Fail Rev
2015[Jul]; 20
(4
): 519-32
PMID25796403
show ga
The left ventricular assist device (LVAD) has become an established treatment
option for patients with refractory heart failure. Many of these patients
experience chronic kidney disease (CKD) due to chronic cardiorenal syndrome type
II, which is often alleviated quickly following LVAD implantation. Nevertheless,
reversibility of CKD remains difficult to predict. Interestingly, initial
recovery of GFR appears to be transient, being followed by gradual but
significant late decline. Nevertheless, GFR often remains elevated compared to
preimplant status. Larger GFR increases are followed by a proportionally larger
late decline. Several explanations for this gradual decline in renal function
after LVAD therapy have been proposed, yet a definitive answer remains elusive.
Mortality predictors of LVAD implantation are the occurrence of either
postimplantation acute kidney injury (AKI) or preimplant CKD. However, patient
outcomes continue to improve as LVAD therapy becomes more widespread, and adverse
events including AKI appear to decline. In light of a growing destination therapy
population, it is important to understand the cumulative effects of long-term
LVAD support on kidney function. Additional research and passage of time are
required to further unravel the intricate relationships between the LVAD and the
kidney.
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