Effects of Ventricular Assist Device Therapies on Renal Function

Left ventricular assist devices (LVADs) have become an established treatment option for advanced heart failure (HF) refractory to conventional medical therapy. LVAD implantation restores cardiac output, improving hemodynamics and reversing neurohormonal dysregulation. The effect of LVAD support on renal pathophysiology is complex and not well understood. Renal dysfunction (RD) occurs commonly in HF patients. Many develop cardiorenal syndrome (CRS), which is often alleviated following LVAD implantation, while others suffer postimplantation acute kidney injury (AKI). Kidney function following LVAD implantation is an important determinant of clinical outcome, and the presence of RD in LVAD recipients is associated with higher mortality, decreased chances of cardiac transplantation, and risk of requiring long-term dialysis. As the number of LVAD recipients grow and live longer with destination therapy, it is critical to understand the cumulative impact of long-term LVAD support on kidney function. This chapter discusses the effects of LVAD on renal pathophysiology and describes the various renal outcomes of patients following LVAD implantation. Clinical recommendations are made in respect of LVAD candidates who have RD.