Renal risk stratification in left ventricular assist device therapy

Left ventricular assist device (LVAD) therapy has greatly reduced mortality for patients with advanced heart failure (HF), both as a bridge to heart transplantation and as destination therapy. However, among other comorbidities, LVAD recipients face a risk of renal dysfunction, related to either the residual effects of HF or to LVAD support, which complicates the management of these patients and increases the risk of an adverse clinical outcome, including death.

The authors summarize the current understanding of pre-LVAD predictors of post-LVAD renal dysfunction and need for renal replacement therapy (RRT), including emerging data about the risk conferred by proteinuria. The authors also discuss dynamics changes in renal function after LVAD placement, the importance of perioperative hemodynamic management in lowering renal risk, and the challenges of managing LVAD patients requiring chronic RRT.

A requirement for RRT before or after LVAD placement portends a high risk of mortality, suggesting a need to identify patients at high risk for post-LVAD RRT. Proteinuria and reduced renal function prior to LVAD placement predict RRT and should be included in the risk assessment of patients being considered for LVAD therapy.