Registry for Radiation Workers, and combined cohort ofnuclear workers in United States future analysis of the registry, which will incorporate all registered cohorts and updated dose histories (in-National cluding internal doses) and have a longer follow up, Atomic homb survivors"0 Registry for Radiation American will provide a firmer basis for deriving risk estimates Whole cohort Doses <_500 mSv Workers workers* from low dose and low dose rate exposures. Cohort size 75 991 95 217 35 933 Person years 2 185 000 1 218 000 705 000 From its inception the registry has been guided by an Collective dose (man Sv) 18 000 3 198 1 140 a Range of doses 0-4 or more 0-0-5 0-0-5 or more 0-0-5 or more avisory committee of eminent epidemiologists. We are Excess relative risk per Sv grateful to themi for their guidance over many years, to Sir
Background and objectives: Patients with end-stage renal failure (ESRD) have an increased risk of premature cardiovascular (CV) disease. Left ventricular hypertrophy is an independent risk factor for CV events and death in ESRD. Renal transplantation has been associated with reduction in CV risk and echocardiographic regression of left ventricular hypertrophy. However, echocardiography overestimates LV mass in ESRD patients. Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measures of cardiac structure. Changes in LV mass measured by CMR after renal transplantation were studied.Design, setting, participants, & measurements: Fifty patients underwent CMR on two occasions. Twenty-five were transplanted before the second scan. CMR was performed to measure LV mass index (LVMI), ejection fraction, end-diastolic and end-systolic volumes. Changes were expressed as percentage change over time. Patients with CV events between scans (e.g., acute coronary syndrome, myocardial infarction) were excluded. All transplant patients had serum creatinine <150 mol/L.Results: There was no significant change in LVMI between patients who underwent renal transplantation and those who remained on dialysis (transplanted mean, 2.75%/yr, ؎ 9.1 versus dialysis, ؊3.6%/yr ؎ 16.7). In addition, there were no significant changes in end-diastolic volume (transplant, 0.1%/yr ؎ 19.5 versus not transplanted, ؊3.4%/yr ؎ 31.5), end-systolic volume (transplanted mean, 15.2%/yr ؎ 65.2 versus not transplanted, 3.0%/yr ؎ 55.5), or ejection fraction (transplant, 2.1%/yr ؎ 11.9 versus not transplanted, ؊0.4%/yr ؎ 5.3).Conclusions: Renal transplantation is not associated with significant regression of LVMI on CMR compared with patients who remain on the transplant waiting list.
This pattern of echocardiographic abnormality is similar to that reported in long-term dialysis populations, despite the adverse effects on survival. Moreover, despite potential benefits of transplantation on cardiac function, left ventricular hypertrophy, ventricular dilatation and systolic dysfunction were all associated with adverse outcome following transplantation. We conclude that echocardiography identifies markers for premature death following transplantation and provides targets for therapeutic intervention.
In this Preliminary Report, we conclude that echocardiographic parameters are associated with adverse outcome in patients receiving renal replacement therapy (RRT). Different echocardiographic parameters are associated with adverse outcome before and after renal transplantation and improvement of pre-transplant abnormalities (e.g. poor LV systolic function) following transplantation does not necessarily confer survival benefits. Whether this is a genuine observation or a reflection of the interpretation of echocardiographic measurements in dialysis patients requires further investigation.
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