Dialysis management after left ventricular assist device implantation: a scoping review of modality, vascular access, and evidence gaps

Abstract Background Renal dysfunction is a common complication in patients supported with left ventricular assist devices (LVADs), and a subset requires long-term renal replacement therapy (RRT). The coexistence of right heart failure (RHF), venous congestion, and hemodynamic instability complicates dialysis management. However, evidence guiding dialysis modality and vascular access selection in this population remains limited, leaving key clinical decisions unsupported. Methods We conducted a scoping review in accordance with the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, Scopus, and the Cochrane Library were searched for studies published between January 2015 and October 2025. We included studies involving adult LVAD recipients requiring maintenance dialysis after LVAD implantation, focusing on dialysis modality, vascular access, clinical outcomes, and RHF. Two reviewers independently screened studies and extracted data. A structured descriptive analysis was performed across predefined domains. Results A total of 31 studies were included, comprising 17 cohort studies, 8 case reports or case series (20 patients), and 6 narrative reviews. All reported LVADs were continuous-flow devices. Hemodialysis was the predominant modality, whereas peritoneal dialysis was suggested as a potential alternative in patients with hemodynamic instability or RHF. Cohort studies rarely reported dialysis modality or vascular access in detail, and no comparative analyses were identified. Vascular access strategies and the impact of RHF on dialysis outcomes were also insufficiently evaluated. Most studies originated from the USA, indicating limited geographic diversity. Conclusions Current evidence does not adequately support clinical decision-making regarding dialysis modality or vascular access in LVAD-supported patients. Despite increasing clinical complexity, key determinants, such as RHF, are not systematically evaluated. Prospective and comparative studies are urgently needed to establish evidence-based dialysis strategies in this population.