Division of Kidney Diseases and Hypertension, Department of Medicine.
Department of Cardiology, and.
Clin J Am Soc Nephrol. 2018 Feb 7;13(2):348-355. doi: 10.2215/CJN.04670417. Epub 2017 Oct 25.
Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.
左心室辅助装置（LVAD）很常见，植入会带来急性肾损伤（AKI）的风险。LVAD 可作为心脏移植的桥接治疗，或作为终末期治疗。患有难治性心力衰竭、慢性心肾综合征和慢性肾脏病（CKD）的患者，在接受 LVAD 植入后通常会有所改善。然而，CKD 的可逆性很难预测。LVAD 植入后，肾小球滤过率（GFR）可能会显著增加，随后 GFR 又恢复到接近基线水平，而在一些患者中，GFR 会下降。在这篇综述中，我们讨论了 LVAD 植入后 GFR 的变化、LVAD 植入后 AKI 的发生率及其与死亡率的关系、需要肾脏替代治疗（RRT）的 AKI 的管理，最后，我们回顾了从 LVAD 经验中学到的关于心肾综合征的显著特征。鉴于越来越多的患者将 LVAD 作为终末期治疗，了解这些设备对肾脏的影响非常重要。需要更多的研究和长期数据来更好地理解 LVAD 和肾脏之间的关系。
