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Effects of Ventricular Assist Device Therapies on Renal Function

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Ventricular-Assist Devices and Kidney Disease

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Abstract

Left ventricular assist devices (LVADs) have become an established treatment option for advanced heart failure (HF) refractory to conventional medical therapy. LVAD implantation restores cardiac output, improving hemodynamics and reversing neurohormonal dysregulation. The effect of LVAD support on renal pathophysiology is complex and not well understood. Renal dysfunction (RD) occurs commonly in HF patients. Many develop cardiorenal syndrome (CRS), which is often alleviated following LVAD implantation, while others suffer postimplantation acute kidney injury (AKI). Kidney function following LVAD implantation is an important determinant of clinical outcome, and the presence of RD in LVAD recipients is associated with higher mortality, decreased chances of cardiac transplantation, and risk of requiring long-term dialysis. As the number of LVAD recipients grow and live longer with destination therapy, it is critical to understand the cumulative impact of long-term LVAD support on kidney function. This chapter discusses the effects of LVAD on renal pathophysiology and describes the various renal outcomes of patients following LVAD implantation. Clinical recommendations are made in respect of LVAD candidates who have RD.

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Acknowledgment

This chapter is the result of work supported with resources and the use of facilities at the Baltimore VA Medical Center, MD.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, University of Maryland School of Medicine and Baltimore VA Medical Center, Baltimore, MD, USA

    Ami M. Patel

  2. Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Karan Kapoor

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

    Michael R. Rudnick

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Correspondence to Ami M. Patel .

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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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Patel, A.M., Kapoor, K., Rudnick, M.R. (2018). Effects of Ventricular Assist Device Therapies on Renal Function. 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_8

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