AKI Prevention and Early Intervention in VAD Patients Admitted for Acute Medical Events.
AKI Prevention and Early Intervention in VAD Patients Admitted for Acute Medical Events.
The investigators are doing this research to investigate whether multifaceted preventive
 measures for newly hospitalized ventricular assist device (VAD) patients will reduce the
 Acute Kidney Injury (AKI) occurrence rate, progression and associated complications
The purpose of the study is to investigate whether preventive measures for newly hospitalized
 ventricular assist device (VAD) patients will reduce the Acute Kidney Injury (AKI) occurrence
 rate, progression and associated complications

 Participants will be in the study for the first 7 days of hospitalization. The study
 investigators will access the electronic medical record daily from admission day 1 through
 admission day 7 in order to provide clinical recommendations in an effort to minimize AKI
 risk as per routine practice.

 If the patient is discharged prior to day 7 the study, intervention will be terminated on day
 of discharge.

 The investigators will review the participant's medical record up to one year after surgery.

 This study will not include any experimental laboratory tests or experimental medication.

 The clinical recommendations will regard the following:

 1. Avoidance of potentially nephrotoxic medications (e.g. NSAIDs, intravascular contrast,
 nephrotoxic antimicrobials)

 2. Optimizing volume status (avoidance of volume overload or depletion)

 3. Optimizing electrolytes and acid-base status

 4. Optimizing hemodynamics (Mean arterial BP>65mmHg)

 5. Assessment of kidney function with serum creatinine and/or cystatin C None of the
 suggestions will be experimental. All suggestions will be based on standard nephrology
 practice.

 The investigators plan to compare the results of the current study with those in in the years
 of 2012-2017 (1/7/2012- 1/7/2017) via retrospective chart review
Inclusion criteria:

 Adult patients with VAD in place who are admitted to the hospital for acute medical illness
 during the study period. For those with multiple admissions during the study period only
 the first admission will be studied.

 Patients who are able to give consent. In case of patients that are mentally impaired we
 will obtain consent from power of attorney and when patients regain intact mental capacity
 we will reobtain consent from the patient.

 Exclusion criteria:

 Patients on dialysis (hemodialysis or peritoneal dialysis).