Implantable Left Ventricular Assist Devices and the Kidney

Mao, Huijuan; Katz, Nevin M.; Kim, Jeong Chul; Day, Sonya; Ronco, Claudio

doi:10.1159/000357970

Cited by 23 publications

(20 citation statements)

References 55 publications

(115 reference statements)

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“…In patients with low cardiac output, biological defense mechanisms maintain perfusion to central organs such as the heart and brain by reducing perfusion to peripheral organs such as the kidney. In such situations, autoregulation leads to a decrease in renal cortical blood flow [10] and may be responsible for clinical AKI (fig. 2).…”

Section: Patient-related Variablesmentioning

confidence: 99%

“…A downregulation of hormonal mechanisms - which are capable of inducing cardiac and renal dysfunction if chronically activated - has been recognized during long-term ventricular support with left ventricular assist devices [10]. However, different effects on hormonal pathways have been identified for acute ventricular support with ECMO (fig.…”

Section: Ecmo-related Variablesmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation and the Kidney

2015

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Background: Extracorporeal membrane oxygenation (ECMO) is an effective therapy for patients with reversible cardiac and/or respiratory failure. Acute kidney injury (AKI) often occurs in patients supported with ECMO; it frequently evolves into chronic kidney damage or end-stage renal disease and is associated with a reported 4-fold increase in mortality rate. Although AKI is generally due to the hemodynamic alterations associated with the baseline disease, ECMO itself may contribute to maintaining kidney dysfunction through several mechanisms. Summary: AKI may be related to conditions derived from or associated with extracorporeal therapy, leading to a reduction in renal oxygen delivery and/or to inflammatory damage. In particular, during pathological conditions requiring ECMO, the biological defense mechanisms maintaining central perfusion by a reduction of perfusion to peripheral organs (such as the kidney) have been identified as pretreatment and patient-related risk factors for AKI. Hormonal pathways are also impaired in patients supported with ECMO, leading to failures in mechanisms of renal homeostasis and worsening fluid overload. Finally, inflammatory damage, due to the primary disease, heart and lung crosstalk with the kidney or associated with extracorporeal therapy itself, may further increase the susceptibility to AKI. Renal replacement therapy can be integrated into the main extracorporeal circuit during ECMO to provide for optimal fluid management and removal of inflammatory mediators. Key Messages: AKI is frequently observed in patients supported with ECMO. The pathophysiology of the associated AKI is chiefly related to a reduction in renal oxygen delivery and/or to inflammatory damage. Risk factors for AKI are associated with a patient's underlying disease and ECMO-related conditions.

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Section: Patient-related Variablesmentioning

confidence: 99%

Section: Ecmo-related Variablesmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation and the Kidney

2015

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“…Not all HF patients have irreversible kidney damage; in fact, kidney function improves markedly early following LVAD placement. LVAD therapy has therefore been suggested as bridge to HTx candidacy: Improved circulation should restore renal function sufficiently to be eligible for HTx [49, 50]. Note that eligibility for LVAD therapy depends on many factors, of which renal function is only one [38, 51].…”

Section: Patient Selectionmentioning

confidence: 99%

Left ventricular assist devices: a kidney’s perspective

2015

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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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“…Bu azalma intravasküler volüm ve atrial natriuretik peptit düşüşünden daha önce gelişmektedir. [305,306] Kısa dönemde renal fonksiyonlarda iyileşme sağlanmaktadır. INTERMACS verilerine göre CF-LVAD hastalarında tedavi öncesine göre GFR ilk 1 ayda artarken 1 yıl içinde düşme göstermiştir.…”

Section: Sürekli Akımın (Cf) Vücut üZerindeki Etkileriunclassified

İleri evre kalp yetersizliği rehberi

Nalbantgil¹,

Çavuşoğlu²,

Akdeniz³

et al. 2018

updates cardiol

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Bu dergide kullanılan kağıt ISO 9706: 1994 standardına uygundur. (Permanence of Paper) National Library of Medicine biyomedikal yayın organlarında asitsiz kağıt (acid-free paper / alkalin kağıt) kullanılmasını önermektedir.Bu eser bilime katkı amacı ile Medtronic'in koşulsuz desteği ile hazırlanmıştır. İçeriğindeki tüm görüş ve iddialar editörlerin ve yazarların kendilerine ait olup, Medtronic ile ilişkilendirilemez.

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Implantable Left Ventricular Assist Devices and the Kidney

Cited by 23 publications

References 55 publications

Extracorporeal Membrane Oxygenation and the Kidney

Extracorporeal Membrane Oxygenation and the Kidney

Left ventricular assist devices: a kidney’s perspective

İleri evre kalp yetersizliği rehberi

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