Chronic kidney disease following left ventricular assist device implantation: contemporary insights and future perspectives

In the last decade, an increasing number of left ventricular assist devices (LVADs) have been implanted to treat patients with end-stage heart failure. Although LVAD therapy improves hemodynamics and survival, it is also associated with potentially life-threatening complications. A common and significant complication following LVAD implantation is chronic kidney disease (CKD), which is associated with high morbidity and mortality. Despite improvements in kidney function early after LVAD implantation, creatinine levels return to pre-implantation levels or higher in the long term. With the increasing number of LVAD implantations in the last decades, it is essential to focus on LVAD-associated CKD in order to improve the outcomes of LVAD therapy. In addition, identifying potential markers for early diagnosis may optimize perioperative management and prevent disease progression, which may now be the only realistic therapeutic option. This review describes the definition, diagnosis, incidence, pathophysiology, and risk factors for CKD after LVAD implantation. Additionally, future perspectives on the prevention and management of CKD in LVAD patients are discussed.