Ventricular Assist Devices and Chronic Kidney Replacement Therapy: Technology and Outcomes

Jawaid, Omar; Gaddy, Anna; Omar, Hesham R.; Guglin, Maya

doi:10.1053/j.ackd.2021.01.002

Cited by 3 publications

(5 citation statements)

References 71 publications

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“…5 First- and second-generation LVADs were implanted in the pre-peritoneal space, competed for space with the PD catheter and were felt to pose unacceptable cardiac infection risk in the event of PD-associated peritonitis. 13,14 Contemporary LVADs have a pre-peritoneal driveline and are not at the same risk of infection in the event of PD-associated peritonitis as earlier VAD iterations. 10 While data are limited, infection concerns empirically support placement of the PD catheter exit-site as far away practicable from the driveline site.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis and LVAD bridge to successful heart–kidney transplant

2022

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Kidney injury and cardio–renal syndrome is a common complication of end-stage cardiomyopathy and heart failure. Although renal function often improves after placement of left ventricular assist devices (LVADs), this is frequently not sustained, and many patients progress to end-stage kidney disease (ESKD). In-centre haemodialysis (HD) is the most common dialysis modality in patients with LVADs and there are only rare case reports of maintenance dialysis with peritoneal dialysis (PD) in patients with VADs. Barriers to the use of PD as renal replacement modality in patients with LVAD include lack of familiarity with acute-start PD, concerns regarding interruption of anticoagulation for PD catheter placement and historic concerns of PD-associated peritonitis risk causing VAD drive-line infection, though this risk is reduced with modern pre-peritoneal VAD drive-lines. PD may offer advantages in this cohort including improved haemodynamic stability and avoidance of vascular access, with lower rates of bloodstream infections as compared to HD. PD may also aid preservation and restoration of kidney function in patients with LVADs and kidney injury. We report a case of a patient with non-ischaemic dilated cardiomyopathy and existing LVAD, with ESKD managed successfully with maintenance PD. The patient was maintained on PD for 10 months prior to a subsequent successful combined heart–kidney transplant.

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Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis and LVAD bridge to successful heart–kidney transplant

2022

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“… 8 Despite the latest research, studies show 50% to 60% of patients experience some form of early kidney recovery following LVAD placement. 19 In one study involving 238 LVAD recipients with reduced preoperative GFR, 43% of bridge-to-transplant and 57% of destination therapy patients recovered renal function to a GFR > 60 mL/min/1.73m 2 within the first year after implantation. 20 Improvement occurred most significantly within the first 3 months following LVAD implantation, after which mean GFR declined slightly yet remained significantly higher than baseline at 1 year post-implantation.…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

“…Jawaid et al note that early improvement in renal function within 6 months of LVAD placement is noted in up to 60% of patients and is attributed to relief of CRS and decongestion as well as reductions in vascular resistance within the kidney due to changes in renal venous pressure, RAAS, and sympathetic activity. 19 Recent literature suggests the early improvement in renal function seen in many studies may not be true improvement in renal function. In many of the studies outlined, estimated GFR (eGFR) is measured by serum creatinine.…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

“…Chronically, within 1 year of LVAD placement, renal deterioration is noted in 79% to 84% of patients and may be attributed to RAAS-induced adverse vascular remodeling, subacute hemolysis with glomerular pigment deposition, and progressive right ventricular failure. 19 Late dysfunction of greater than 1 year after LVAD placement is noted in up to 50% of patients and may be attributed to RAAS-induced adverse vascular remodeling, subacute hemolysis with glomerular pigment deposition, progressive right ventricular failure, and microthromboembolism. 19 …”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

“… 19 Late dysfunction of greater than 1 year after LVAD placement is noted in up to 50% of patients and may be attributed to RAAS-induced adverse vascular remodeling, subacute hemolysis with glomerular pigment deposition, progressive right ventricular failure, and microthromboembolism. 19 …”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

See 2 more Smart Citations

Renal Dysfunction in Patients with Left Ventricular Assist Device

Nihum¹,

Manian²,

Arunachalam³

et al. 2022

Methodist DeBakey Cardiovascular Journal

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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.

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Impact of Diabetes Mellitus on Outcomes in Patients with Left Ventricular Assist Devices

Crugnola,

Cinquina,

Mattimore

et al. 2024

Biomedicines

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Heart failure (HF) represents a significant health burden in the United States, resulting in substantial mortality and healthcare costs. Through the array of treatment options available, including lifestyle modifications, medications, and implantable devices, HF management has evolved. Left ventricular assist devices (LVADs) have emerged as a crucial intervention, particularly in patients with advanced HF. However, the prevalence of comorbidities such as diabetes mellitus (DM) complicates treatment outcomes. By elucidating the impact of DM on LVAD outcomes, this review aims to inform clinical practice and enhance patient care strategies for individuals undergoing LVAD therapy. Patients with DM have higher rates of hypertension, dyslipidemia, peripheral vascular disease, and renal dysfunction, posing challenges to LVAD management. The macro/microvascular changes that occur in DM can lead to cardiomyopathy and HF. Glycemic control post LVAD implantation is a critical factor affecting patient outcomes. The recent literature has shown significant decreases in hemoglobin A1c following LVAD implantation, representing a possible bidirectional relationship between DM and LVADs; however, the clinical significance of this decrease is unclear. Furthermore, while some studies show increased short- and long-term mortality in patients with DM after LVAD implantation, there still is no literature consensus regarding either mortality or major adverse outcomes in DM patients.

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Ventricular Assist Devices and Chronic Kidney Replacement Therapy: Technology and Outcomes

Cited by 3 publications

References 71 publications

Peritoneal dialysis and LVAD bridge to successful heart–kidney transplant

Peritoneal dialysis and LVAD bridge to successful heart–kidney transplant

Renal Dysfunction in Patients with Left Ventricular Assist Device

Impact of Diabetes Mellitus on Outcomes in Patients with Left Ventricular Assist Devices

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