Kidney health and function with left ventricular assist devices

Abstract

Purpose of reviewMechanical circulatory support (MCS) is a group of evolving therapies used for indications ranging from temporary support during a cardiac procedure to permanent treatment of advanced heart failure. MCS is primarily used to support left ventricle function, in which case the devices are termed left ventricular assist devices (LVADs). Kidney dysfunction is common in patients requiring these devices, yet the impact of MCS itself on kidney health in many settings remains uncertain.Recent findingsKidney dysfunction can manifest in many different forms in patients requiring MCS. It can be because of preexisting systemic disorders, acute illness, procedural complications, device complications, and long-term LVAD support. After durable LVAD implantation, most persons have improvement in kidney function; however, individuals can have markedly different kidney outcomes, and novel phenotypes of kidney outcomes have been identified.SummaryMCS is a rapidly evolving field. Kidney health and function before, during, and after MCS is relevant to outcomes from an epidemiologic perspective, yet the pathophysiology underlying this is uncertain. Improved understanding of the relationship between MCS use and kidney health is important to improving patient outcomes.

Emerging strategies to reduce kidney function decline and improve cardiovascular outcomes

“…Garcia and Walther discuss the impact of mechanical circulatory support on kidney health and function, with an emphasis on LVADs [7]. LVADs, the most commonly used type of durable mechanical circulatory support, are specifically used for left ventricular support and have been employed for short-term support until cardiac transplantation but are increasingly being used for permanent support.…”