Renal Replacement Therapy in Patients with Left Ventricular Assist Device: What do the Cardiologists Need to Know?

Abstract

Renal failure after left ventricular assist device (LVAD) implantation occurs either due to worsening chronic kidney disease which is common in end-stage heart failure, or due to acute kidney injury in the peri-implantation period, and is associated with high morbidity and shortterm mortality. The increased utilization of LVAD in refractory heart failure either as a bridge to transplantation or destination therapy will eventually create a population of patients with LVADs who are dialysis-dependent. There are multiple challenges encountered during dialysis of patients with LVADs including the unfamiliarity of nephrologists with the LVAD technology, difficulty in hemodynamic monitoring with continuous flow devices, risk of access site infection or bleeding and poor arteriovenous fistula maturation and these reasons are the source for the reluctance of outpatient dialysis centers to accept such cases. The nephrologists as well as cardiologists should be familiar with these obstacles to avoid adverse consequences to these high risk patients. Herein, we explore the challenges encountered during dialysis of patients with LVADs.