Relationship Between Renal Function and Left Ventricular Assist Device Use

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

“…Haglund and colleagues found that those with GFR < 45 mL/min/ 1.73 m 2 were less likely to survive after heart transplantation [4]. In additional analyses, baseline creatinine clearance (CrCl) < 47 cc/min and creatinine (Cr) > 1.96 mg/dL have been associated with increased mortality risk after implantation [5,6]. While these findings highlight the challenges of managing advanced HF patients with concomitant renal failure, low kidney function prior to implantation may not necessarily exclude LVADs as a therapeutic option.…”

“…The Cr and GFR thresholds for LVAD implantation, especially as bridging therapy, may warrant modification, in light of evidence that patients with marked kidney dysfunction nevertheless derive benefit from LVADs. In these patients, while LVADs may help to resolve acute and subacute changes in renal function due to hemodynamic perturbations, intrinsic and structural kidney damage is likely more difficult to reverse with LVAD therapy [3,5]. Therefore, careful assessment of changes in renal function during the first several weeks after LVAD placement may serve as a critical tool for predicting outcomes and guiding management.…”

“…There is also evidence to suggest that patients with GFR < 60 mL/min/ 1.73 m 2 who recover their renal function to GFR ≥ 60 mL/ min/1.73 m 2 have similar survival compared to those with baseline and postimplant GFR ≥ 60 mL/min/1.73 m 2 [12]. In a study using a different renal function parameter, patients with baseline CrCl ≤ 50 mL/min whose renal function increased to CrCl > 50 mL/min experienced a greater 30- day survival rate than those with baseline CrCl < 50 mL/min whose renal function remained < 50 mL/min [5]. Brisco and colleagues described an intriguing phenomenon in which large improvements and deteriorations in renal function were both associated with greater risk of mortality, potentially because the reference group for this analysis consisted of patients with more stable renal function and less significant cardiorenal syndrome [13].…”

“…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].…”

“…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.…”