Kidney Medicine, 2021
Authors: Mike Ajuria, Douglas D. Franz, John T. Morris III, Graham Abra, Wael F. Hussein
Acute kidney injury (AKI) complicates up to 50% of left ventricular assist device (LVAD) placements and up to 30% of these patients require dialysis. Despite advances in LVAD technology since the first-generation devices, the risk for AKI remains high. We present a case of a woman in her 50s with previously stable stage C heart failure who developed critical cardiogenic shock and resultant AKI. She required continuous kidney replacement therapy both before and after placement of an LVAD. Following multiple inpatient and outpatient hemodialysis sessions complicated by hypotension, she was transitioned to peritoneal dialysis (PD). She tolerated PD well, and her kidney function continued to improve during the following weeks. After 6 weeks of outpatient PD, she recovered kidney function, allowing for cessation of dialysis. PD is a good option for patients with advanced heart failure who receive an LVAD due to gentler ultrafiltration, decreased risk for bacteremia, and better preservation of kidney function as compared with hemodialysis.