Successful weaning from hemodialysis of patient with acute kidney injury after left ventricular assist device implantation： A case report

Abstract

A man in his 40s underwent surgery for valvular disease. Postoperatively, he could not be weaned off cardiopulmonary bypass, and was admitted to the intensive care unit with a percutaneous cardiopulmonary support device. As his cardiac function did not improve, an extracorporeal left ventricular assist device (LVAD) was attached on the 8th day after valvular surgery. After LVAD attachment, his urine output decreased, and hemodialysis was initiated due to acute kidney injury (AKI). He experienced fluid retention of 14 kg above his preoperative weight, with the central venous pressure elevated to 20 mmHg. This led to a diagnosis of AKI due to right heart failure. Fluid management strategies successfully reduced the patient’s weight by 2 kg from his preoperative baseline, subsequently improving urine output and enabling the discontinuation of dialysis. Right heart failure after LVAD implantation is estimated to occur in approximately 20‒40％ of cases, often resulting in AKI due to a reduced effective glomerular filtration rate caused by renal vein congestion. The key to treatment is appropriate fluid volume management, with this case culminating in reversible AKI.