Tromp T R, de Jonge N, Joles J A
University Medical Center Utrecht, POB 85500, 3508 GA, Utrecht, The Netherlands,
Heart Fail Rev. 2015 Jul;20(4):519-32. doi: 10.1007/s10741-015-9481-z.
The left ventricular assist device (LVAD) has become an established treatment option for patients with refractory heart failure. Many of these patients experience chronic kidney disease (CKD) due to chronic cardiorenal syndrome type II, which is often alleviated quickly following LVAD implantation. Nevertheless, reversibility of CKD remains difficult to predict. Interestingly, initial recovery of GFR appears to be transient, being followed by gradual but significant late decline. Nevertheless, GFR often remains elevated compared to preimplant status. Larger GFR increases are followed by a proportionally larger late decline. Several explanations for this gradual decline in renal function after LVAD therapy have been proposed, yet a definitive answer remains elusive. Mortality predictors of LVAD implantation are the occurrence of either postimplantation acute kidney injury (AKI) or preimplant CKD. However, patient outcomes continue to improve as LVAD therapy becomes more widespread, and adverse events including AKI appear to decline. In light of a growing destination therapy population, it is important to understand the cumulative effects of long-term LVAD support on kidney function. Additional research and passage of time are required to further unravel the intricate relationships between the LVAD and the kidney.
左心室辅助装置（LVAD）已成为难治性心力衰竭患者的既定治疗选择。这些患者中的许多人因慢性II型心肾综合征而患有慢性肾脏病（CKD），在植入LVAD后，这种情况通常会迅速缓解。然而，CKD的可逆性仍然难以预测。有趣的是，肾小球滤过率（GFR）的初始恢复似乎是短暂的，随后会逐渐但显著地出现后期下降。尽管如此，与植入前状态相比，GFR通常仍会升高。GFR升高幅度越大，后期下降幅度相应越大。针对LVAD治疗后肾功能逐渐下降的情况，已经提出了几种解释，但仍没有明确的答案。LVAD植入的死亡率预测因素是植入后急性肾损伤（AKI）或植入前CKD的发生。然而，随着LVAD治疗越来越广泛，患者的预后持续改善，包括AKI在内的不良事件似乎也在减少。鉴于接受目标治疗的患者群体不断扩大，了解长期LVAD支持对肾功能的累积影响非常重要。需要更多的研究和时间推移来进一步阐明LVAD与肾脏之间的复杂关系。
