TOPIC Discussion: LVAD and the Kidney

Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR.

In a recent review in CJASN, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience.

Salient points   

Most of the AKI and CKD post LVAD is related to right ventricular failure. Identifying that and providing aggressive diuresis and or UF might be important.
Long term CKD related to LVAD might be related to hemolysis and R-CHF.
Hemodialysis and PD – both can be successfully be done in outpatient setting with LVADs
AVF should be still the first choice for LVAD patients in the outpatient settings that require dialysis e
The most important of all, interdisciplinary teams including cardiologist, surgeons, and nephrologists are critical in the success of an LVAD program.