eGFR Trajectory in LVAD Recipients with Right Heart Failure: Status Quo or a Steady Decline?

wo outcomes particularly dreaded after left ventricular assist device (LVAD) implantation are development of right heart failure (RHF) and worsening kidney function. Yet for better or worse, right heart function and kidney function are innately intertwined (Figure). Increased venous return, left ventricular (LV) unloading, changes in systemic afterload, intraoperative factors, the effects of chronic heart failure (HF) on right ventricular function, and conformational changes in how ventricles twist as a result of LVAD being sewn into LV can all contribute to the development of postoperative RHF. 1 Chronic kidney disease itself may contribute to the development of RHF via reduced glomerular filtration rate (GFR), tubular dysfunction, renin-angiotensin-aldosterone system activation, and possibly other mechanisms such as uremic toxin build-up and higher FGF-23 levels. 2-5 RHF may adversely affect kidney function predominantly through elevated systemic venous pressure, which leads to a cascade of downstream effects all culminating in reduced GFR and reduced diuretic efficiency, with cardiac underfilling likely playing a more minor role. e Article by Walther et al.