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Aldhaheri FA, Koussayer S, Khail B, Abedrabo W, Ubaid Ullah M. Native Arteriovenous Fistula Creation in Patients With Continuous Flow Left Ventricular Assist Devices: A Case Report and a Narrative Review. Cureus 2023; 15:e43751. [PMID: 37727192 PMCID: PMC10506624 DOI: 10.7759/cureus.43751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/21/2023] Open
Abstract
Worsening of kidney function after left ventricular assist device (LVAD) implantation is common, and many patients reaching end-stage kidney disease require long-term dialysis. Permanent vascular access in a patient with LVAD remains a clinical dilemma. There is a theoretical concern about the maturation of the arteriovenous fistula in a patient with LVAD due to the absence of a pulsatile flow in these patients. We described a case of successful creation of a left brachial-cephalic AVF in a patient with continuous flow LVAD (Abbott's HeartMate 3TM), which was used for dialysis without issue.
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Affiliation(s)
| | - Samer Koussayer
- Vascular Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Bassam Khail
- Vascular Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Wesam Abedrabo
- Nursing, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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2
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Toma K, Stevens JS, Morrissey NJ, Yuzefpolskaya M, Radhakrishnan J, Husain SA. Successful Use of Arteriovenous Graft for Hemodialysis Access After Left Ventricular Assist Device Placement. Kidney Med 2021; 3:1091-1094. [PMID: 34939019 PMCID: PMC8664732 DOI: 10.1016/j.xkme.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kidney replacement therapy is required in up to one-third of patients after left ventricular assist device (LVAD) placement. A subset of these patients requires long-term maintenance hemodialysis and therefore needs durable vascular access but the ideal access in such patients has not been established. We present a series of 3 patients in whom arteriovenous grafts (AVGs) were successfully used for long-term kidney replacement therapy after LVAD placement. The maximum time from AVG placement to first successful AVG use was 40 days, and the longest AVG use duration was more than 2 years. 2 patients required AVG excision due to infection but both had successful placement of a second AVG. Total time on kidney replacement therapy was 993, 1,055, and 956 days for the 3 cases, of which dialysis catheter use was required for only 23%, 6.5%, and 27%, respectively. These cases suggest that AVG placement is a viable option for dialysis access in patients with LVADs.
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Affiliation(s)
- Katherine Toma
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
| | - Jacob S Stevens
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
| | - Nicholas J Morrissey
- Department of Surgery, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
| | - S Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY
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3
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Jawaid O, Gaddy A, Omar HR, Guglin M. Ventricular Assist Devices and Chronic Kidney Replacement Therapy: Technology and Outcomes. Adv Chronic Kidney Dis 2021; 28:37-46. [PMID: 34389136 DOI: 10.1053/j.ackd.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Heart failure and kidney failure are very common conditions, precipitating and exacerbating each other. Left ventricular assist devices (LVADs) represent a relatively new technology for treatment of advanced heart failure. Kidney dysfunction, if present, makes candidate selection for LVADs challenging and contributes to multiple complications while the patients are on an LVAD support. Although kidney function generally improves after LVAD implantation, some patients develop acute and then chronic kidney disease sometimes requiring kidney replacement therapies (KRTs). Overall, chronic KRT in LVAD recipients is feasible and well tolerated, but routine technique of blood pressure monitoring should be adjusted to the continuous blood flow. Both hemodialysis and peritoneal dialysis can be used. Unique challenges for chronic KRT posed by the presence of LVAD are discussed in this review.
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Trends, Outcomes, and Readmissions Among Left Ventricular Assist Device Recipients with Acute Kidney Injury Requiring Hemodialysis. ASAIO J 2020; 66:507-512. [PMID: 31192850 DOI: 10.1097/mat.0000000000001036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although renal function may improve after left ventricular assist devices (LVAD) implantation, acute kidney injury (AKI) requiring hemodialysis (HD) therapy can occur postoperatively. We used data from the National Readmissions Database to calculate annual rates of in-hospital outcomes and readmissions among patients who underwent implantation and developed acute kidney injury (AKI) requiring hemodialysis (HD) for years 2012-2015. We identified 178 (weighted 469) patients with AKI requiring HD after LVAD implantation. In-hospital mortality was significantly higher among LVAD recipients who required HD for AKI compared with those who did not (42.38% vs. 8.38%, p < 0.001). Rates of in-hospital mortality (from 52.1% in 2012 to 33.9% in 2014, p = 0.046) and length of stay (from 60.3 days in 2012 to 47.1 days in 2014, p = 0.003) decreased significantly, whereas there was a trend toward reduced hospital cost (from $320,414 in 2012 to $267,285 in 2014, p = 0.076) during the study period. However, postoperative bleeding increased significantly (p = 0.01). Acute kidney injury requiring HD after implantation was not associated with significantly higher rates of readmissions compared with LVAD recipients without AKI on HD, after adjustment for clinical and hospital characteristics (41.4% vs. 30.5%; odds ratio 1.28; 95% confidence interval [CI]: 0.85-1.95; P = 0.239). However, 5.42% of these patients required maintenance hemodialysis in readmissions. In-hospital mortality and length of stay are decreasing but remain unacceptably high in patients requiring HD for AKI after LVAD implantation but remain higher than LVAD recipients without AKI on HD. A minority of these patients who survive hospital discharge require maintenance hemodialysis.
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Safaya A, Bhuta K, Rajdeo H. Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices. Ann Vasc Surg 2020; 70:568.e13-568.e17. [PMID: 32890641 DOI: 10.1016/j.avsg.2020.08.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/15/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Renal dysfunction, requiring renal replacement therapy (RRT) is commonly encountered in patients with left ventricular assist devices (LVADs). Continuous flow LVAD (CFLVAD) is the most widely used device. Nonpulsatile blood flow begets special hemodynamic changes. This poses a unique challenge in choosing a long-term dialysis access for patients with CFLVAD where life expectancy is limited. METHODS A 61-year-old man with an implanted CFLVAD and renal dysfunction receiving intermittent RRT through a nontunneled dialysis catheter had progressed to dialysis-dependent renal failure. He was referred to us for a permanent hemodialysis access. RESULTS The patient underwent a right brachio-brachial arterio-venous graft (AVG) placement. The graft was successfully cannulated for hemodialysis on postoperative day 15. On regular follow-up at 18 months, the graft was still functional. CONCLUSIONS Dialysis access for patients on LVAD is an exceptional management problem owing to both altered physiology and guarded overall prognosis. We recommend the use of AVG as a convenient and durable option-facilitating early cannulation and expediting freedom from indwelling catheters that may lead to catastrophic consequences. This should limit the need for secondary interventions, hospitalization, and cost, thus improving quality of life.
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Affiliation(s)
- Aditya Safaya
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Kalyani Bhuta
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Heena Rajdeo
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
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6
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El Ela AA, Tang PC. Commentary: Permanent dialysis access following total artificial heart implantation: A question of maturity. JTCVS Tech 2020; 3:225-226. [PMID: 34317881 PMCID: PMC8305694 DOI: 10.1016/j.xjtc.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ashraf Abou El Ela
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
| | - Paul C. Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
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Roehm B, Gulati G, Weiner DE. Heart failure management in dialysis patients: Many treatment options with no clear evidence. Semin Dial 2020; 33:198-208. [PMID: 32282987 PMCID: PMC7597416 DOI: 10.1111/sdi.12878] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure with reduced ejection fraction (HFrEF) impacts approximately 20% of dialysis patients and is associated with high mortality rates. Key issues discussed in this review of HFrEF management in dialysis include dialysis modality choice, vascular access, dialysate composition, pharmacological therapies, and strategies to reduce sudden cardiac death, including the use of cardiac devices. Peritoneal dialysis and more frequent or longer duration of hemodialysis may be better tolerated due to slower ultrafiltration rates, leading to less intradialytic hypotension and better volume control; dialysate cooling and higher dialysate calcium may also have benefits. While high-quality evidence exists for many drug classes in the non-dialysis population, dialysis patients were excluded from major trials, and only limited data exist for many medications in kidney failure patients. Despite limited evidence, beta blocker and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use is common in dialysis. Similarly, devices such as implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy that have proven benefits in non-dialysis HFrEF patients have not consistently been beneficial in the limited dialysis studies. The use of leadless pacemakers and subcutaneous ICDs can mitigate future hemodialysis access limitations. Additional research is critical to address knowledge gaps in treating maintenance dialysis patients with HFrEF.
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Affiliation(s)
- Bethany Roehm
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Gaurav Gulati
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Daniel E. Weiner
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, MA
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Salem KM, Abou Ali AN, Sue E, Mohapatra A, Eid RE, Kormos RL, Chaer RA, Avgerinos ED. Maturation of arteriovenous fistulas in patients with ventricular assist devices. J Vasc Access 2019; 21:176-179. [PMID: 31364480 DOI: 10.1177/1129729819865706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Postoperative renal dysfunction necessitating hemodialysis after implantation of ventricular assist devices presents a challenge with respect to establishment of hemodialysis access. Lack of pulsatile flow has led to concerns that arteriovenous fistulas will not mature. This study aims to evaluate arteriovenous fistula as a method of hemodialysis. METHODS Consecutive patients who underwent implantation of a ventricular assist device between 1988 and 2016 with a subsequent need for hemodialysis were identified. Retrospective data were collected for patients requiring hemodialysis through an arteriovenous fistula or arteriovenous graft. Access flow rates and duration of patency are reported. RESULTS Sixty-four patients were identified (10 required long-term hemodialysis, 5 via arteriovenous fistula, 1 via arteriovenous graft). All six patients receiving long-term hemodialysis access were on continuous-flow ventricular assist devices. Brachiocephalic arteriovenous fistulas were performed in all arteriovenous fistula patients, and the average preoperative vein diameter was 4.1 ± 0.9 mm. On 30-day follow-up, the average flow rate was 1262 ± 643 mL/min (880-2220). In arteriovenous fistula patients, one died at 30 days, one arteriovenous fistula required ligation for steal syndrome at 5 months, and one was abandoned after 10.7 months for low flow. Of remaining fistulas, one was converted to an arteriovenous graft at 1.7 years for malfunction (with 5.3 month patency), and one remains open at 4.0 years. CONCLUSION Arteriovenous fistulas should be considered in selected patients with ventricular assist devices as a means of long-term hemodialysis access to avoid use of catheters. Maturation and usage of primary arteriovenous fistulas is possible despite lack of pulsatile flow.
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Affiliation(s)
- Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adham N Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Erika Sue
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abhisekh Mohapatra
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raymond E Eid
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert L Kormos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Asleh R, Schettle S, Briasoulis A, Killian JM, Stulak JM, Pereira NL, Kushwaha SS, Maltais S, Dunlay SM. Predictors and Outcomes of Renal Replacement Therapy After Left Ventricular Assist Device Implantation. Mayo Clin Proc 2019; 94:1003-1014. [PMID: 31171114 DOI: 10.1016/j.mayocp.2018.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/25/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the frequency and outcomes of patients requiring renal replacement therapy (RRT) early after left ventricular assist device (LVAD) implantation. PATIENTS AND METHODS We examined use of in-hospital RRT and outcomes in consecutive adults who underwent continuous-flow LVAD implantation from February 15, 2007, through August 8, 2017. Logistic regression was used to examine predictors of RRT. The associations of RRT with outcomes were examined using Cox proportional hazards regression. RESULTS Of 354 patients who underwent LVAD implantation, 54 (15%) required in-hospital RRT. Patients receiving RRT had higher preoperative Charlson Comorbidity Index values (median, 5 vs 4; P=.03), Model for End-Stage Liver Disease scores (mean, 19.0 vs 14.5; P<.001), right atrial pressure (mean, 19.1 vs 13.4 mm Hg; P<.001), and estimated 24-hour urine protein levels (median, 357 vs 174 mg; P<.001) and lower preoperative estimated glomerular filtration rate (eGFR) (median, 43 vs 57 mL/min; P<.001) and measured GFR using 125I-iothalamate clearance (median, 33 vs 51 mL/min; P=.001) than those who did not require RRT. Approximately 40% of patients with eGFR less than 45 mL/min/1.73 m2 and 24-hour urine protein level greater than 400 mg required RRT vs 6% with eGFR greater than45 mL/min/1.73 m2 and without significant proteinuria. Lower preoperative eGFR, higher estimated 24-hour urine protein level, higher right atrial pressure, and longer cardiopulmonary bypass time were independent predictors of RRT after LVAD implantation. Of patients requiring in-hospital RRT, 18 (33%) had renal recovery, 18 (33%) required outpatient hemodialysis, and 18 (33%) died before hospital discharge. After median (Q1, Q3) follow-up of 24.3 (8.9, 49.6) months, RRT was associated with increased risk of death (adjusted hazard ratio [HR], 2.86; 95% CI, 1.90-4.33; P<.001) and gastrointestinal bleeding (adjusted HR, 4.47; 95% CI, 2.57-7.75; P<.001). CONCLUSION In-hospital RRT is associated with poor prognosis after LVAD. A detailed preoperative assessment of renal function before LVAD may be helpful in risk stratification and patient selection.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Sarah Schettle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John M Stulak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Naveen L Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Simon Maltais
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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10
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Khawaja A, Lim HS, Howell NJ, Inston N. Arteriovenous fistula creation in a patient without a pulse: Vascular access in patients with left ventricular assist devices. J Vasc Access 2019; 20:760-762. [PMID: 30704342 DOI: 10.1177/1129729819826029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Left ventricular assist devices are used in heart failure patients as bridge to transplantation or increasingly as a destination therapy. These patients frequently have renal dysfunction and many reach end-stage renal failure. If haemodialysis is required, minimization of infection risk is essential. Arteriovenous grafts have been recommended for these patients due to hypothetical concerns regarding fistula maturation due to continuous flow. A case is described where a brachiocephalic arteriovenous fistula was successfully formed and used for dialysis without issue. This is one case of a small number in the literature where arteriovenous fistulas have been used in left ventricular assist device patients and it appears that concerns are unfounded and good outcomes have been reported. It would appear from this experience that approaches to vascular access for dialysis in patients with continuous-flow left ventricular assist devices are in accordance with vascular access guidelines and standard practice.
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Affiliation(s)
- Aurangzaib Khawaja
- Department of Renal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - Hoong Sern Lim
- Department of Cardiac Transplantation, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - Neil J Howell
- Department of Cardiac Transplantation, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
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11
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Walther CP, Niu J, Winkelmayer WC, Cheema FH, Nair AP, Morgan JA, Fedson SE, Deswal A, Navaneethan SD. Implantable Ventricular Assist Device Use and Outcomes in People With End-Stage Renal Disease. J Am Heart Assoc 2018; 7:JAHA.118.008664. [PMID: 29980520 PMCID: PMC6064848 DOI: 10.1161/jaha.118.008664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background People with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort. Methods and Results We performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance. Conclusions Medicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.
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Affiliation(s)
- Carl P Walther
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Jingbo Niu
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Faisal H Cheema
- Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX
| | - Ajith P Nair
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jeffrey A Morgan
- Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX.,Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX
| | - Savitri E Fedson
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Anita Deswal
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX.,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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12
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Ross DW, Stevens GR, Wanchoo R, Majure DT, Jauhar S, Fernandez HA, Merzkani M, Jhaveri KD. Left Ventricular Assist Devices and the Kidney. Clin J Am Soc Nephrol 2018; 13:348-355. [PMID: 29070522 PMCID: PMC5967423 DOI: 10.2215/cjn.04670417] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.
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Affiliation(s)
- Daniel W. Ross
- Division of Kidney Diseases and Hypertension, Department of Medicine
| | | | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Department of Medicine
| | | | | | - Harold A. Fernandez
- Department of Cardiothoracic Surgery, Hofstra Northwell School of Medicine, Northwell Health, North Shore University Hospital, Manhasset, New York
| | - Massini Merzkani
- Division of Kidney Diseases and Hypertension, Department of Medicine
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine
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13
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Roehm B, Vest AR, Weiner DE. Left Ventricular Assist Devices, Kidney Disease, and Dialysis. Am J Kidney Dis 2018; 71:257-266. [DOI: 10.1053/j.ajkd.2017.09.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022]
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14
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Givens RC, Topkara VK. Renal risk stratification in left ventricular assist device therapy. Expert Rev Med Devices 2017; 15:27-33. [DOI: 10.1080/17434440.2018.1418663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Raymond C. Givens
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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