Renal Dysfunction in Patients with Left Ventricular Assist Device

Abstract

Late-stage heart failure and renal dysfunction are often seen in conjunction. Cardiorenal syndrome (CRS) describes the complex interaction between the two disease states. Early literature described the pathophysiology of CRS as related only to reduced cardiac output and decreased renal perfusion. Recent literature suggests a more multifaceted mechanism. Left ventricular assist devices (LVAD), used as bridge-to-transplant and destination therapy in patients with heart failure, impact not only cardiac function but also renal function, especially in those patients with preoperative renal dysfunction. The mechanism by which LVAD implantation affects renal function is complex and understated in early literature. In this review, we discuss the pathogenesis of CRS, the impact of preoperative renal dysfunction in patients undergoing LVAD implantation, and the effect of LVAD implantation on postoperative renal function.

Left Ventricular Assist Devices and Renal Ramifications

“…The decline in renal function over time may be multifactorial because of right ventricular dysfunction, venous congestion, reduced pulsatility, and/or ongoing maladaptive neurohormonal mechanisms. 20 Furthermore, the influence of race and sex on LVAD outcomes becomes essential, as demonstrated in this current study. Additional investigation is necessary to understand the mechanisms that lead to these outcome differences and how to truly measure renal function in the context of inflammation and sarcopenia that accompanies advanced heart failure.…”

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

“…In addition, as described above, LVAD devices facilitate adequate perfusion and homeostasis, leading to improved organ function, cardiopulmonary performance, and QoL. However, some studies suggest negative effects of long-term use of LVADs on organ function, which is particularly relevant today [ 22 , 23 , 24 , 25 ]. To better understand the impact of LVAD use on QoL, hemodynamically stable BTT patients ( INTERMACS 4) were compared to hemodynamically stable HTx listed patients who were theoretically eligible for LVAD implantation.…”