Renal insufficiency is common in patients with chronic heart failure. There are two pathologic processes involved in etiology of this type of renal insufficiency: first is the decrease in end organ perfusion as a result of reduction in cardiac output of the failing heart, second is the vascular nephrosclerosis resulting from atherosclerosis as part of the underlying disease process. This paper outlines the benefit of mechanical assist device implantation in improving renal function. After a rapid improvement of renal functions after biventricular assist device implantation in our patient with dilated cardiomyopathy we were able to avoid combined heart and kidney transplant and proceed with an isolated heart transplant.