Impact of renal function recovery utilizing left ventricular assist device support

Quader, Mohammed; Goodreau, Adam M; Johnson, Ryan M.; Wolfe, Luke; Feldman, George M.

doi:10.1111/jocs.14320

Cited by 4 publications

(8 citation statements)

References 36 publications

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“…When using eGFR, we observed the same trajectory as for mGFR following MCS implantation and subsequent HTx. Our findings were in line with previous publications in which estimated GFR was applied as an assessment for renal function 8,10,15,31 . The majority of patients in CKD‐stage 3–4 (66%) improved to stage 1–2 after MCS.…”

Section: Discussionsupporting

confidence: 92%

“…Candidates for heart transplantation (HTx) with CRS may receive durable mechanical circulatory support (MCS) as a bridge‐to‐transplantation (BTT) with the intention to improve renal function. Despite the risk for acute kidney injury, an MCS implantation may facilitate renal function through increased cardiac output and reduced venous congestion 7–11 . However, the increase in glomerular filtration rate (GFR) after MCS observed in different studies 8,12,13 does not appear to be sustained over time.…”

Section: Introductionmentioning

confidence: 99%

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The trajectory of renal function following mechanical circulatory support and subsequent heart transplantation

et al. 2022

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Aim Patients with advanced heart failure (HF) frequently suffer from renal insufficiency. The impact of durable mechanical circulatory support (MCS) and subsequent heart transplantation (HTx) on kidney function is not well described. Methods and results We studied patients with advanced HF who received durable MCS as bridge to transplantation (BTT) and underwent subsequent HTx at our centre between 1996 and 2018. Glomerular filtration rate (GFR) was measured by 51Cr‐EDTA or iohexol clearance during heart failure work‐up; 3–6 months after MCS; and 1 year after HTx. Chronic kidney disease (CKD) was classified according to KDIGO criteria based on estimated GFR. A total of 88 patients (46 ± 15 years, 84% male) were included, 63% with non‐ischaemic heart disease. The median duration of MCS‐treatment was 172 (IQR 116–311) days, and 81 subjects were alive 1 year after HTx. Measured GFR increased from 54 ± 19 during HF work‐up to 60 ± 16 mL/min/1.73 m2 after MCS (P < 0.001) and displayed a slight but nonsignificant decrease to 57 ± 22 mL/min/1.73 m2 1 year after HTx (P = 0.38). The trajectory of measured GFR did not differ between pulsatile and continuous flow (CF) pumps. Among patients 35–49 years and those who were treated in the most recent era (2012–2018), measured GFR increased following MCS implantation and subsequent HTx. Estimated GFR displayed a similar course as did measured GFR. Conclusions In patients with advanced heart failure, measured GFR improved after MCS with no difference between pulsatile and CF‐pumps. The total study group showed no further increase in GFR following HTx, but in certain subgroups, including patients aged 35–54 years and those treated during the latest era (2012–2018), renal function appeared to improve after transplant.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The trajectory of renal function following mechanical circulatory support and subsequent heart transplantation

et al. 2022

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“…The eGFR improves in the first month after LVAD implantation, even in patients experiencing post-LVAD AKI. [35][36][37][38] There have even been some reports of patients quitting the chronic dialysis required for CKD 5. 39 In the study by Borgi et al, 37 a month after LVAD implantation, eGFR improved by 20% in 60% of patients, and by more than 50% in the other 40% patients, regardless of the device strategy or INTERMACS class.…”

Section: Early Effectsmentioning

confidence: 99%

“…The eGFR improves in the first month after LVAD implantation, even in patients experiencing post‐LVAD AKI 35‐38 . There have even been some reports of patients quitting the chronic dialysis required for CKD 5 39 .…”

Section: Effects Of Lvad Support On Renal Functionmentioning

confidence: 99%

“…As extensively explained in this review, LVAD implantation can have various effects on RF. Generally speaking, after a slight early increase in eGFR 35‐38 (that does not reflect any genuine recovery of RF), most patients experience a worsening kidney function over the medium‐long term 41,42 . This is important, particularly considering the strong association between renal impairment and several adverse outcomes—mortality above all.…”

Section: Limitations Of Available Studies and Perspectivesmentioning

confidence: 99%

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Heart, kidney and left ventricular assist device: a complex trio

Gambaro

Lombardi

Gottin

et al. 2021

Eur J Clin Investigation

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Background: Heart failure (HF) is a complex syndrome affecting the whole body, kidneys included. The left ventricular assist device (LVAD) is a valid option for patients with very severe HF. Focusing on renal function, LVAD implantation could theoretically reverse the detrimental effects of HF syndrome on kidneys. However, implanting an LVAD is a high-risk surgical procedure, and LVAD patients have higher risk of bleeding, device thrombosis, strokes, renal impairment, multi-organ failure and infections. Furthermore, an LVAD has its own particular effects on the renal system. Methods: In this review, we provide a comprehensive overview of the complex interaction between LVAD and the kidneys from the pathophysiological and clinical perspectives. An analysis of the different effects of pulsatile-flow and continuousflow LVAD is provided. Results: Despite their limitations, creatinine-based estimated glomerular filtration rate (eGFR) formulas help to stratify patients by their post-LVAD placement prognosis. Poor basal renal function, the onset of acute kidney injury or the need for renal replacement therapy after LVAD implantation negatively influences a patient's prognosis. LVAD can also prompt an improvement in renal function, however, with some counterintuitive effects on a patient's prognosis. Conclusion: It is still hard to say whether different trends in eGFR depend on different renal conditions before LVAD placement, on a patient's better overall status or on a particular patient management strategy before and/or after the device's implantation. Steps should be taken to solve this question because finding the best candidates for LVAD implantation is of paramount importance to ensure the best outcomes.

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Selection Criteria for Durable Mechanical Circulatory Support

Mody

Adler

2021

Case-Based Device Therapy for Heart Failure

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Impact of renal function recovery utilizing left ventricular assist device support

Cited by 4 publications

References 36 publications

The trajectory of renal function following mechanical circulatory support and subsequent heart transplantation

The trajectory of renal function following mechanical circulatory support and subsequent heart transplantation

Heart, kidney and left ventricular assist device: a complex trio

Selection Criteria for Durable Mechanical Circulatory Support

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