Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Abstract

Introduction We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients. Methods We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardiography in 43 kidney transplant recipients with a transplant duration of ≥6 months, no acute rejection and a glomerular filtration rate of ≥15 mL/min/1.73m 2 . Results Mean (SD; range) transplant duration was 12.3 (8.0; 0.5–33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established confounder adjusted analysis, haemoglobin (partial R =−0.394, p=0.01) and parathyroid hormone concentrations (partial R =0.382, p=0.02) were associated with E/e’. In multivariable analysis, haemoglobin (partial R =−0.278, p=0.01) and parathyroid levels (partial R =0.324, p=0.04) were independently associated with E/e’. Waist–height ratio (partial R =−0.526, p=0.001 and partial R =−0.355, p=0.03), waist circumference (partial R =−0.433, p=0.008 and partial R =−0.393, p=0.02) and body mass index (partial R =−0.332, p=0.04 and partial R =−0.489, p=0.002) were associated with both e’ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/e’ (partial R =−0.422, p=0.02), parathyroid hormone-E/e’ (partial R =0.434, p=0.03), waist–height ratio-e’ (partial R =−0.497, p=0.007) and body mass index-E/A (partial R =−0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures. Conclusion Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyperparathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.

Aortic Stiffness and Pulsatile Pressures as Potential Mediators of Chronic Kidney Disease Induced Impaired Diastolic Function

“…Notably, although not significant, Pf was directly related to e’ and accounted for 26.3% of the CKD-e’ relationship in product of coefficient mediation analysis. Since this concurred with a significant direct association between cardiac preload as indexed by LVEDV, 10 , 11 with e’, increased Pf was likely flow mediated and a consequence rather than a cause of left ventricular relaxation.…”

“…Additionally, whether the timing of measurement during the interdialytic period influences findings in relation to the impact of aortic function on diastolic function in CKD merits future research. As applies to previously reported studies by us, 10 , 11 , 13 our aim was to determine relationships of recorded characteristics with e’ and E/e’, which necessitates including low as well as high values. In this regard, since we did not determine atrial volume index and tricuspid regurgitation velocity, we could not apply suggested algorithms for the identification of diastolic dysfunction as recently reported by Nagueh et al 31 Our study was designed prior to Nagueh report.…”

Uric Acid, Ferritin, Albumin, Parathyroid Hormone and Gamma-Glutamyl Transferase Concentrations are Associated with Uremic Cardiomyopathy Characteristics in Non-Dialysis and Dialysis Chronic Kidney Disease Patients

“… 19 We recently reported that persistent secondary hyperparathyroidism is independently associated with impaired diastolic function in stable kidney transplant recipients. 22 In the present study, parathyroid levels were associated with left ventricular mass and inappropriate left ventricular mass. Notably, our results show for the first time that the potential impact of parathyroid hormone levels on left ventricular mass is equally strong in non-dialysis as it is in dialysis patients (interaction p=0.682 to 0.709).…”

“…Echocardiography was performed in accordance with the American Society of Echocardiography convention 22 and employing a Philips CX50 POC Compact CompactXtreme Ultrasound System (Philips Medical Systems (Pty) Ltd, USA) equipped with a 1.8–4.2 MHz probe that allowed for M-mode, 2-D, pulsed and tissue Doppler measurements. Our methodology was previously described.…”

“…Our methodology was previously described. 22 , 23 Patients were examined in the partial left decubitus position. We assessed left ventricular geometry and systolic (lateral s’ and ejection fraction) and diastolic (e’ as a measure of active relaxation and E/e’ as an index of passive relaxation and left ventricular filling pressure).…”