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Selection for Ventricular Assist Device Placement in Patients with Chronic Kidney Disease

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Ventricular-Assist Devices and Kidney Disease

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Abstract

Use of left ventricular assist devices (LVAD) in the treatment of advanced heart failure has increased significantly in recent years. Renal dysfunction is commonly associated with advanced heart failure and is an indicator of poor outcomes. In this chapter, we review factors that affect the clinical outcomes of LVAD implantation in patients with renal dysfunction, with an eye toward improved patient selection.

Renal dysfunction and the need for hemodialysis prior to LVAD implantation increase mortality after LVAD implantation. Although renal function generally improves during the first 1–3 months after LVAD implantation, it can regress to baseline or stay slightly above pre-implantation value by 1 year. Patients with improved renal function after LVAD implantation had improved survival and transplantation rates. Some factors that predict worsening of renal function and poor outcomes in the immediate post-LVAD period are cardiorenal syndrome type II with ischemic changes and renal fibrosis; long-standing, poorly controlled diabetes or hypertension; and need for hemodialysis or CVVHD after LVAD implantation. Improvement in renal function with optimal medical therapy and intra-aortic balloon pump use prior to LVAD implantation were predictors for post-LVAD renal function improvement.

Renal dysfunction should not be bundled into a single category in patients being evaluated for LVAD implantation because there are reversible causes for renal dysfunction in this population. A thorough work-up of renal failure will help to prevent withdrawal of this life-saving therapy from advanced heart failure patients.

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Abbreviations

CF:

Continuous-flow

CrCl:

Creatinine clearance

CVVHD:

Continuous veno-venous hemodialysis

eGFR:

Estimated glomerular filtration rate

HF:

Heart failure

INTERMACS:

Interagency Registry for Mechanical Assisted Circulatory Support

LVAD:

Left ventricular assist device

MCS:

Mechanical circulatory support

PF:

Pulsatile-flow

RAAS:

Renin–angiotensin–aldosterone system

References

  1. Cleland JG, Carubelli V, Castiello T, Yassin A, Pellicori P, Antony R. Renal dysfunction in acute and chronic heart failure: prevalence, incidence and prognosis. Heart Fail Rev. 2012;17(2):133–49.

    Article  CAS  PubMed  Google Scholar 

  2. Brisco MA, Kimmel SE, Coca SG, Putt ME, Jessup M, Tang WW, et al. Prevalence and prognostic importance of changes in renal function after mechanical circulatory support. Circ Heart Fail. 2014;7(1):68–75.

    Article  PubMed  Google Scholar 

  3. Kirklin JK, Naftel DC, Kormos RL, Pagani FD, Myers SL, Stevenson LW, et al. Quantifying the effect of cardiorenal syndrome on mortality after left ventricular assist device implant. J Heart Lung Transplant. 2013;32(12):1205–13. https://doi.org/10.1016/j.healun.2013.09.001.

    Article  PubMed  Google Scholar 

  4. Sandner SE, Zimpfer D, Zrunek P, Rajek A, Schima H, Dunkler D, et al. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg. 2009;87(4):1072–8. https://doi.org/10.1016/j.athoracsur.2009.01.022.

    Article  PubMed  Google Scholar 

  5. Butler J, Geisberg C, Howser R, Portner PM, Rogers JG, Deng MC, et al. Relationship between renal function and left ventricular assist device use. Ann Thorac Surg. 2006;81(5):1745–51.

    Article  PubMed  Google Scholar 

  6. Iwashima Y, Yanase M, Horio T, Seguchi O, Murata Y, Fujita T, et al. Effect of pulsatile left ventricular assist system implantation on Doppler measurements of renal hemodynamics in patients with advanced heart failure. Artif Organs. 2012;36(4):353–8.

    Article  PubMed  Google Scholar 

  7. Sandner SE, Zimpfer D, Zrunek P, Dunkler D, Schima H, Rajek A, et al. Renal function after implantation of continuous versus pulsatile flow left ventricular assist devices. J Heart Lung Transplant. 2008;27(5):469–73.

    Article  PubMed  Google Scholar 

  8. Welp H, Rukosujew A, Tjan TD, Hoffmeier A, Kösek V, Scheld HH, et al. Effect of pulsatile and non-pulsatile left ventricular assist devices on the renin-angiotensin system in patients with end-stage heart failure. Thorac Cardiovasc Surg. 2010;58(Suppl 2):S185–8.

    Article  PubMed  Google Scholar 

  9. Hasin T, Topilsky Y, Schirger JA, Li Z, Zhao Y, Boilson BA, et al. Changes in renal function after implantation of continuous-flow left ventricular assist devices. J Am Coll Cardiol. 2012;59(1):26–36.

    Article  PubMed  Google Scholar 

  10. Khot UN, Mishra M, Yamani MH, Smedira NG, Paganini E, Yeager M, et al. Severe renal dysfunction complicating cardiogenic shock is not a contraindication to mechanical support as a bridge to cardiac transplantation. J Am Coll Cardiol. 2003;41(3):381–5.

    Article  PubMed  Google Scholar 

  11. Demirozu ZT, Etheridge WB, Radovancevic R, Frazier OH. Results of HeartMate II left ventricular assist device implantation on renal function in patients requiring post-implant renal replacement therapy. J Heart Lung Transplant. 2011;30(2):182–7.

    Article  PubMed  Google Scholar 

  12. James KB, McCarthy PM, Thomas JD, Vargo R, Hobbs RE, Sapp S, et al. Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure. Circulation. 1995;92(9 Suppl):II191–5.

    Article  CAS  PubMed  Google Scholar 

  13. Labban B, Arora N, Restaino S, Markowitz G, Valeri A, Radhakrishnan J. The role of kidney biopsy in heart transplant candidates with kidney disease. Transplantation. 2010;89(7):887–93.

    Article  PubMed  Google Scholar 

  14. Kihara S, Litwak KN, Nichols L, Litwak P, Kameneva MV, Wu Z, et al. Smooth muscle cell hypertrophy of renal cortex arteries with chronic continuous flow left ventricular assist. Ann Thorac Surg. 2003;75(1):178–83; discussion 183.

    Article  PubMed  Google Scholar 

  15. Naik A, Akhter SA, Fedson S, Jeevanandam V, Rich JD, Koyner JL. Acute kidney injury and mortality following ventricular assist device implantation. Am J Nephrol. 2014;39(3):195–203.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The authors gratefully acknowledge Jennifer Pfaff and Susan Nord of Aurora Cardiovascular Services for editorial preparation of the manuscript and Brian Miller and Brian Schurrer from Aurora Research Institute for help in preparing the figures.

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Authors and Affiliations

  1. Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Milwaukee, WI, USA

    Nasir Z. Sulemanjee

  2. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Nasir Z. Sulemanjee

  3. Penn Presbyterian Medical Center, Perleman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Michael R. Rudnick

  4. Geisinger Medical Center, Danville, PA, USA

    Mamatha Pinninti

Authors
  1. Nasir Z. Sulemanjee
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  2. Michael R. Rudnick
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  3. Mamatha Pinninti
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Corresponding author

Correspondence to Nasir Z. Sulemanjee .

Editor information

Editors and Affiliations

  1. Director, Nephrology, Solid Organ Transplantation and Advanced Heart Failure Therapies, Advocate Christ Medical Center, University of Illinois, Oak Lawn, Illinois, USA

    Chaitanya Desai

  2. Clinical Associate Professor of Medicine University of Illinois, Clinical Director, Heart Transplantation and Mechanical Assistance, Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    William G. Cotts

  3. Clinical Professor of Medicine, Section of Nephrology, University of Illinois at Chicago, College of Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

  4. Associate Professor of Medicine, Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Cente, Perleman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Michael R. Rudnick

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Sulemanjee, N.Z., Rudnick, M.R., Pinninti, M. (2018). Selection for Ventricular Assist Device Placement in Patients with Chronic Kidney Disease. In: Desai, C., Cotts, W., Lerma, E., Rudnick, M. (eds) Ventricular-Assist Devices and Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-74657-9_7

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  • DOI: https://doi.org/10.1007/978-3-319-74657-9_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74656-2

  • Online ISBN: 978-3-319-74657-9

  • eBook Packages: MedicineMedicine (R0)

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