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Review
. 2018 Feb 7;13(2):348-355.
doi: 10.2215/CJN.04670417. Epub 2017 Oct 25.

Left Ventricular Assist Devices and the Kidney

Daniel W Ross  1 , Gerin R Stevens  2 , Rimda Wanchoo  1 , David T Majure  2 , Sandeep Jauhar  2 , Harold A Fernandez  3 , Massini Merzkani  1 , Kenar D Jhaveri  1
Affiliations
Review

Left Ventricular Assist Devices and the Kidney

Daniel W Ross et al. Clin J Am Soc Nephrol. .

Abstract

Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.

Keywords: Acute Kidney Injury; Cardio-Renal Syndrome; Chronic; Heart Transplantation; Heart-Assist Devices; Humans; Incidence; LVAD; Renal Insufficiency; Renal Replacement Therapy; cardiorenal; cardiovascular disease; congestive heart failure; glomerular filtration rate; kidney.

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Figures

Figure 1.
Figure 1.
Components of the HeartMate II. (A) HeartMate II LVAD. The device has four components: implantable pump, driveline, external power source (e.g., batteries), and a system controller. Blood travels from the apex of the left ventricle through the inflow cannula, into the pump, and out via a graft that is attached to the ascending aorta and to the systemic circulation effectively bypassing the aortic valve. The system controller has a display screen that shows key device parameters. Power must always be supplied by two sources, either both batteries or via the power module, which is used in the home during sleeping hours. (B) A closeup of the HeartMate II system controller. Patients or caregivers can scroll through the different parameters (speed, flow, power, and pulsatility index) by pushing a button on the controller. One can also determine the amount of charge left in the batteries to avoid running too low. Images provided courtesy of St. Jude Medical, Inc. LVAD, left ventricular assist device.
Figure 2.
Figure 2.
Many factors contribute to early and late AKI after LVAD. Postulated mechanisms of immediate AKI and late stage AKI. ATN, acute tubular necrosis; CHF, congestive heart failure.
See this image and copyright information in PMC

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