Abstract
The left ventricular assist device (LVAD) has become an established treatment option for patients with refractory heart failure. Many of these patients experience chronic kidney disease (CKD) due to chronic cardiorenal syndrome type II, which is often alleviated quickly following LVAD implantation. Nevertheless, reversibility of CKD remains difficult to predict. Interestingly, initial recovery of GFR appears to be transient, being followed by gradual but significant late decline. Nevertheless, GFR often remains elevated compared to preimplant status. Larger GFR increases are followed by a proportionally larger late decline. Several explanations for this gradual decline in renal function after LVAD therapy have been proposed, yet a definitive answer remains elusive. Mortality predictors of LVAD implantation are the occurrence of either postimplantation acute kidney injury (AKI) or preimplant CKD. However, patient outcomes continue to improve as LVAD therapy becomes more widespread, and adverse events including AKI appear to decline. In light of a growing destination therapy population, it is important to understand the cumulative effects of long-term LVAD support on kidney function. Additional research and passage of time are required to further unravel the intricate relationships between the LVAD and the kidney.
Highlights
1–2 % of the adult population in developed countries suffers from heart failure (HF) [1]
Improvement in renal function after left ventricular assist device (LVAD) implantation largely relies on reversal of several factors, both hemodynamic and non-hemodynamic, attributed to chronic Cardiorenal syndrome (CRS) type II
With a growing number of destination therapy (DT) patients, and the fact that LVADs are to be used for significantly longer periods of time, it is of the utmost importance to ascertain the causes of decreasing renal function
Summary
1–2 % of the adult population in developed countries suffers from heart failure (HF) [1]. Patient outcomes continue to improve as LVAD therapy becomes more widespread, and adverse events including AKI appear to decline.
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