Results of HeartMate II left ventricular assist device implantation on renal function in patients requiring post-implant renal replacement therapy

Abstract

Renal function is often compromised in patients with advanced heart failure. We evaluated renal function in heart failure patients supported by the HeartMate II (Thoratec Corporation, Pleasanton, CA) continuous-flow left ventricular assist device (LVAD) who required renal replacement therapy (RRT) by continuous venovenous hemofiltration dialysis (CVVHD) or hemodialysis, or both. Indications for RRT included oliguria (urine < 400 ml/day) unresponsive to diuretic therapy for > 24 hours with a creatinine level > 2.0 mg/dl or 1.5 times that of the pre-implant creatinine level, severe acidemia, and volume overload. Of 107 consecutive patients who underwent HeartMate II implantation at our center and had been supported for > 30 days, 15 (13 men and 2 women) required post-implant RRT. Of the 15 patients, 3 received CVVHD and 12 received CVVHD and hemodialysis. Renal function improved within 2 months of support compared with average values before support (creatinine clearance, 64 ± 39 vs 92 ± 55 ml/min, p = 0.041; glomerular filtration rate, 46.9 ± 20.7 vs 73.2 ± 38.9 ml/min/1.73 m(2); p = 0.032). Renal function improved after HeartMate II implantation in 10 patients, and RRT was removed. Of these 10 patients, 2 underwent heart transplantation 4 months after RRT was removed, 1 underwent heart and kidney transplantation 4 years later, 2 died at home of conditions unrelated to renal function 6 months after RRT was removed, and 5 are awaiting heart transplantation, with good quality of life. In this study, patients who experienced clinical recovery after the LVAD implant had subsequent recovery of renal function after continuous-flow LVAD support.