Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

“Cardiorenal syndrome” is a term used to describe a dysregulationof the heart affecting the kidneys, or vice versa, in an acute or chronic manner( 1 , 2 ). Renal impairment canrange from reversible ischemic damage to renal failure requiring short- orlong-term renal replacement therapy ( 2 ). Patients who require mechanicalcirculatory support, such as a left ventricular assist device (LVAD), asdefinitive treatment for congestive heart failure or as a bridge to cardiactransplantation pose a unique challenge with respect to receiving dialysis,because they experience higher rates of morbidity and mortality from infectionin the post-LVAD period ( 3- 7 ). Acute dialysis access can pose anincreased infection risk.In this article, we present a patient who required renal replacement therapy anda LVAD for management of acute-on-chronic cardiorenal syndrome while awaitingheart transplantation. A literature review to determine whether peritonealdialysis or hemodialysis is superior for patients with profound hemodynamicdysfunction and the need to minimize risk of infection did not offer clearguidance about which modality is superior in patients with advanced congestiveheart failure. However, there is clear evidence of the superiority of peritonealdialysis in reducing the risk of systemic infection secondary to acute dialysisaccess. Given the high risk of LVAD infection, we therefore conclude that, todecrease mortality secondary to systemic infection, peritoneal dialysis shouldstrongly be considered in patients who require renal replacement therapy beforeor after LVAD placement.