Outcome of patients with ventricular assist devices and acute renal failure requiring renal replacement therapy

The significance of acute renal failure (ARF) for patients treated with a v entricular assist device (VAD) is uncertain. There is little information on the outcome of patients who require renal replacement therapy during treat ment with a VAD. A retrospective review was undertaken to evaluate the impa ct of renal failure requiring renal replacement therapy on such patients. S tudied were 227 patients who were supplied with a VAD at the German Heart I nstitute Berlin. Fifty-five patients required renal replacement therapy dur ing treatment with a VAD. These were compared with patients not needing ren al replacement therapy (ARF and non-ARF groups). Significant differences fo r the end points of survival, heart transplantation, and discharge from hos pital were observed in patients with ARF (p < 0.01). Survival was then anal yzed according to indications for treatment with a VAD (bridge to transplan tation or cardiac recovery after cardiotomy, transplantation, myocardial in farction, myocarditis, and endocarditis). Survival for bridge-to-transplant ation patients was clearly influenced in a negative way by ARF (p < 0.01). For cardiac recovery patients, only a small difference in survival was obse rved (p = 0.05). We conclude that ARF is a negative predictor for bridge-to -transplantation patients. for cardiac recovery patients the impact of ARF on survival is marginally significant.