Heart, kidney and left ventricular assist device: a complex trio

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Heart failure (HF) significantly impacts systemic organs, including the kidneys.
• Left ventricular assist devices (LVADs) are an option for severe HF, with theoretical renal benefits but also significant risks like bleeding and organ impairment.
• LVADs exert unique effects on the renal system.

Purpose of the Study:

• To comprehensively review the complex pathophysiological and clinical interactions between LVADs and kidney function.
• To analyze the distinct effects of pulsatile-flow versus continuous-flow LVADs on renal parameters.

Main Methods:

• Literature review synthesizing current knowledge on LVADs and renal function.
• Analysis of pathophysiological mechanisms and clinical outcomes.
• Comparison of pulsatile-flow and continuous-flow LVAD impacts.

Main Results:

• Creatinine-based estimated glomerular filtration rate (eGFR) formulas aid in stratifying post-LVAD prognosis.
• Pre-existing renal dysfunction, acute kidney injury, or need for renal replacement therapy post-LVAD worsens prognosis.
• LVADs can improve renal function, but with sometimes counterintuitive prognostic effects.

Conclusions:

• The reasons for varying eGFR trends post-LVAD (pre-existing renal conditions, patient status, management strategies) remain unclear.
• Further research is needed to elucidate these factors.
• Identifying optimal LVAD candidates is crucial for improving patient outcomes.