Outcomes With Left Ventricular Assist Device in End-Stage Renal Disease: A Systematic Review

Abstract

Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from mechanical circulatory support (MCS). Unfortunately, renal function may result after left ventricular assist device (LVAD) implantation. The purpose of this study is to examine the outcomes of advanced heart failure patients with end-stage renal disease (ESRD) requiring mechanical circulatory support as a bridge to transplant (BTT) or destination therapy (DT). We searched Medline, Embase, and Cochrane in September 2021. The following keywords were used: left ventricular assist device or LVAD and end-stage renal disease or ESRD. Our study included case reports, case series, descriptive studies, and randomized control trials. Review articles, guidelines, systematic reviews, and meta-analyses were excluded. We also excluded pediatric cases. We identified 278 articles; 92 were duplicated, 186 articles entered the screening phase, and 133 articles were excluded by title and abstract. After the full-text screening, 40 articles were excluded. This systematic review included 13 articles. Among the contraindications to LVAD implantation, a general contraindication is for patients found to have stage 4 chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR): <30 mL/minute/1.73 m 2 ), while those on dialysis are an absolute contraindication LVAD implantation. Despite the limited data and publications on LVADs in patients with ESRD, LVAD implantation as a bridge to transplantation or destination therapy may be considered in selected patients without increasing morbidity and mortality. Therefore, shared decision-making around the treatment of advanced heart failure with these patients and the care team is essential.

Cardiac Device Therapy in Patients with Chronic Kidney Disease: An Update

“…However, there was not strong enough evidence to support a causal effect between the increased post-LVAD mortality and ESRD. Complications such as infection, stroke, bleeding, older age, or comorbidities-more frequently seen in ESRD-could also increase the mortality and lead to a poor prognosis [48,49].…”

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

“…Some essential kidney variables should be carefully studied before deciding on DT-LVAD: Firstly, glomerular function and laboratory biomarkers. Patients with eGFR < 30 mL/min/ 1.73 m 2 , calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) [68], or on dialysis are generally ineligible for this therapy [69][70][71] due to their high mortality (40.6% during hospitalization and 61.5% at 1-year [72]). The change in kidney function over time provides a lot of information: decline in GFR (maximum physiological expected 1 mL/min/1.73 m 2 per year), especially if it is rapid, is strongly related to poor prognosis.…”

Cardiac Device Therapy in Patients with Chronic Kidney Disease – an Update

“…However, there was not strong enough evidence to support a causal effect between the increased post-LVAD mortality and ESRD. Complications such as infection, stroke, bleeding, older age or comorbiditiesmore frequently seen in ESRD -could also increase the mortality and lead to a poor prognosis [43,44].…”