Impact of Renal Function Before Mechanical Circulatory Support on Posttransplant Renal Outcomes

Singh, Manjulata; Shullo, M.; Kormos, Robert L.; Lockard, K.L.; Zomak, R.; Simon, Marc A.; Bermúdez, C.; Bhama, Jay K.; McNamara, Dennis M.; Toyoda, Yoshiya; Teuteberg, Jeffrey J.

doi:10.1016/j.athoracsur.2010.10.036

Cited by 56 publications

(54 citation statements)

References 13 publications

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“…Russell et al similarly found that patients with compromised baseline renal function (described as mean Cr > 1.8 mg/dL) experienced reductions in Cr that were sustained 6 months after LVAD implantation [8]. Even in the setting of more significant baseline renal impairment, defined as CrCl < 45 mL/min or GFR < 45 mL/min/1.73 m 2 in two studies, renal function still remained improved until 1 year after implantation [9,10]. Restoring cardiac output thus provides renal benefits.…”

Section: Change In Renal Function After Lvad Implantation and Effect mentioning

confidence: 97%

“…Restoring cardiac output thus provides renal benefits. Moreover, the improvements in renal function occur and stabilize during the first 1-2 months after LVAD implantation [3,5,[7][8][9][10].…”

Section: Change In Renal Function After Lvad Implantation and Effect mentioning

confidence: 99%

“…Even though preoperative renal impairment is associated with increased mortality [3][4][5][6], renal function may improve after LVAD implantation [7][8][9][10] and contribute to better survival [3,5,[11][12][13]. With much discussion in the literature regarding patient selection for LVADs [14], the present editorial offers a perspective on the clinical relevance of pre-LVAD renal function as well as post-LVAD changes in kidney function.…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist devices in patients with renal dysfunction: where are we heading?

Daimee

Kutyifa

2017

Expert Review of Medical Devices

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Section: Change In Renal Function After Lvad Implantation and Effect mentioning

confidence: 97%

Section: Change In Renal Function After Lvad Implantation and Effect mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist devices in patients with renal dysfunction: where are we heading?

Daimee

Kutyifa

2017

Expert Review of Medical Devices

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“…5) Several authors including us have reported that ventricular assist device (VAD) implantation can reverse endorgan dysfunction signifi cantly. 15,16) Currently, approximately 90% of Japanese recipients require VAD support for bridge to HTx, 7) mainly because of the progressive decline in end-organ function that occurs in most patients with end-stage heart failure. Fortunately, he could be managed without VAD implantation until HTx, but preserving renal function was especially important considering the long waiting period before HTx.…”

Section: Discussionmentioning

confidence: 99%

Successful Conversion From Thiazide to Tolvaptan in a Patient With Stage D Heart Failure and Chronic Kidney Disease Before Heart Transplantation

et al. 2013

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SummaryChronic kidney disease (CKD) is often complicated with advanced heart failure because of not only renal congestion and decreased renal perfusion but also prolonged use of diuretics at higher doses, which sometimes results in hyponatremia. Preoperative CKD is known to be associated with poor prognosis after heart transplantation (HTx). We experienced a stage D heart failure patient with CKD and hyponatremia who was switched from trichlormethiazide to tolvaptan. His hyponatremia was normalized, and his renal function was improved after conversion to tolvaptan. In patients with stage D heart failure, it may be useful to administer tolvaptan with a concomitant reduction in the dose of diuretics in order to preserve renal function and avoid hyponatremia before HTx. (Int Heart J 2013; 54: 48-50) Key words: Hyponatremia, Diuretics, Renal dysfunction C hronic kidney disease (CKD) and hypervolemic hyponatremia are often complicated with advanced heart failure, and are not only attributable to renal congestion and reduced renal perfusion but also to extended use of diuretics at higher doses.1-5) Heart transplantation (HTx) is the comprehensive solution for patients with stage D heart failure refractory to optimal medical therapy thus far, 6) but it is well known that preoperative CKD results in a poor prognosis after HTx.7) It is especially important to preserve preoperative renal function since postoperative immunosuppressive therapy cannot help some kinds of renal impairment. 8) We experienced a stage D heart failure patient with CKD who was administered tolvaptan (TLV) and a vasopressin type 2 (V2) receptor antagonist, along with discontinuation of trichlormethiazide. His hyponatremia normalized and his renal function improved. Furthermore, his renal function remained within an acceptable range after HTx under immunosuppressive therapy including a calcineurin inhibitor. Case ReportThe patient was a 53-year-old male with ischemic cardiomyopathy (Figure 1, Table) who had received coronary artery bypass surgery in March 2010. His heart failure worsened even after the bypass surgery, and he eventually became dependent on intravenous infusion of inotropes regardless of maximum medical therapy including carvedilol, enalapril, spironolactone, trichlormethiazide, and furosemide in August 2010. He was transferred to our hospital as a possible candidate for HTx in September 2010. His laboratory data on admission showed 137 mEq/L of serum sodium, 1.9 mg/dL of serum total bilirubin, 1.2 mg/dL of serum creatinine, and 636 pg/mL of plasma B-type natriuretic peptide. Transthoracic echocardiography indicated an ejection fraction of 28% and left ventricular diastolic diameter of 67 mm. A hemodynamic study performed in December 2010 demonstrated that mean right atrial pressure was 2 mmHg, mean pulmonary capillary wedge pressure was 21 mmHg, and the cardiac index was 2.2 L/minute/m 2 under continuous infusion of inotropes. He was then listed in February 2011 as a recipient of HTx. In the meantime, his serum creatinine increased...

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“…Placement of an LVAD in patients with ESHD invariably improves renal function with more than half of patients with CrCl <45 mL/min achieving a CrCl !60 mL/min 30 days after implant (5). The lack of analyses of patient outcomes who have received an LVAD also creates a major weakness in the current analysis.…”

mentioning

confidence: 99%

To Transplant a Kidney With the Heart or Not—That Is the Real Question

Kumar

Tallaj

2014

American Journal of Transplantation

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Impact of Renal Function Before Mechanical Circulatory Support on Posttransplant Renal Outcomes

Cited by 56 publications

References 13 publications

Left ventricular assist devices in patients with renal dysfunction: where are we heading?

Left ventricular assist devices in patients with renal dysfunction: where are we heading?

Successful Conversion From Thiazide to Tolvaptan in a Patient With Stage D Heart Failure and Chronic Kidney Disease Before Heart Transplantation

To Transplant a Kidney With the Heart or Not—That Is the Real Question

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