Kidney Replacement Therapies in Advanced Heart Failure: Timing, Modalities and Clinical Considerations

Acute kidney dysfunction is commonly encountered in patients with advanced heart failure (HF), and it carries significant prognostic implications, often leading to poorer outcomes and increased mortality rates. It can alter the course of decision making for left ventricular assist device (LVAD) and cardiac transplantation candidacy. Kidney replacement therapies (KRTs) offer a critical intervention in this context but require careful consideration of timing, various types of KRT modalities and individual patients' preferences and circumstances. This review discusses the intricacies of KRT in advanced HF, examining how to optimize timing and choose among the various KRT modalities. It also provides a detailed discussion of the unique clinical scenarios that clinicians may face when treating this vulnerable patient group.