Patients with refractory congestive heart failure may be considered for implantation of a left ventricular assist device (LVAD). Renal failure after LVAD placement can occur to varying degrees from cardiorenal syndrome (CRS) or due to intrinsic renal disease. Patients with severely impaired renal function after LVAD may require renal replacement therapy (RRT) as a temporary or permanent means of support. We present a unique case of a patient who initiated peritoneal dialysis (PD) 1 year after placement of an LVAD for destination therapy (DT). One year later, PD continues to be successfully utilized by this patient for RRT. There are several proven and theoretical benefits to PD in LVAD patients. Peritoneal dialysis can provide sustained daily ultrafiltration offering greater hemodynamic stability, preservation of residual renal function, and a lower risk of systemic infection. Conversely, limitations to PD include nutritional risks due to peritoneal albumin losses, hyperglycemia, and potential limitations to successful catheter placement. Considering our patient’s successful outcome and the potential benefits associated with PD, despite the limitations, we conclude that PD should strongly be considered in patients with LVADs that require RRT.