AKI Prevention and Early Intervention in Patients Undergoing VAD Placement

AKI Prevention and Early Intervention in Patients Undergoing VAD Placement

The investigators are doing this research to find out if more careful assessment and elimination of potential risk factors of acute kidney injury (AKI) during the subject's perioperative period will reduce their chance of kidney damage and kidney damage related problems.

The purpose of the study is to investigate whether preventive measures for patients undergoing ventricular assist device (VAD) placement will reduce AKI occurrence, progression and associated complications.

Participants will be in the study for a total of 6 days (1 day prior to the surgery and 5 days after the surgery). The investigators will review the participant's medical record up to one year after surgery.

The study investigators will access the participant's electronic medical record 24 hours prior to the planned VAD implantation and review the participant's medication regimen and provide recommendations to the participant's primary care physician in an effort to minimize potential risks for AKI. There will be no intervention during the operation.

The clinical recommendations will cover the following:

1. Avoidance of potentially nephrotoxic agents.
2. Optimizing volume status (avoidance of volume overload or depletion)
3. Optimizing electrolytes and acid-base status
4. Minimizing IV contrast exposure when appropriate
5. Treating severe anemia
6. Optimization of hemodynamics (Mean arterial BP>65mmHg).

The investigators plan to compare the results of this study with the historical data in the same patient population in the years of 7/1/2015-6/30/2017.

Inclusion criteria:

• Adult patients that will undergo VAD placement.
• Patients able to give consent

Exclusion criteria:

• Patients on dialysis (hemodialysis or peritoneal dialysis)
• Non-elective VAD placement (VAD implantation decision made within 24 hours)