Predictors of Left Ventricular Remodelling in Kidney Transplant Recipents in the First Posttransplant Year

Abstract

Cardiovascular diseases (CVD) are a major cause of morbidity and leading cause of mortality in almost 50% of patients (pts) with chronic kidney disease (CKD), including kidney transplant recipients. Left ventricular hypertrophy (LVH) is the most common structural alteration and powerful risk factor for cardiovascular complications in the uremic patients. The aim of this study is to analyze predictors of the left ventricular remodelling in the first year after kidney transplantation based on comparison of echocardiographic findings, which had been done before and twelve months after transplantation. In five years retrospective study, we followed up 30 kidney transplant patients in the first post-transplant year. All patients data - blood pressure, BMI, ECG, blood haemoglobin, serum protein, calcium, phosphorus, product of calcium and phosphorus, the values of parathyroid hormone, serum creatinine and creatinine clearance were recorded just before kidney transplantation and in one month interval after transplantation in the first post-transplant year. Echocardiographic examination was done before transplantation and one year after kidney transplantation. Before transplantation, 33% of patients had normal echocardiographic finding and 67% of patients had echocardiographic signs of left ventricular hypertrophy. After first post-transplant year, 63% of patients showed normal echocardiographic finding of LV, while 37% of patients remained with LV hypertrophy. Diastolic dysfunction of LV until the end of study had been reduced in 40% of pts compared to 70% pts at the beginning of the study. The positive echocardiographic remodelling of LV significantly correlated with rising values of haemoglobin (p<0.05), creatinine clearance (p=0.039) and with the reduction of the serum creatinine values (p=0.047), as well as values of parathyroid hormone (p=0.022). These results confirmed positive relationship between echocardiographic remodelling of left ventricular hypertrophy and elimination uraemia-related risk factors after successful renal transplantation.

Uremic Cardiomyopathy: An Underdiagnosed Disease

“…In one study, the percentage of patients with LVH shown on echocardiography declined after the first post‐transplant year from 67% to 37%, confirming the positive relationship between LVH and the elimination of uremia‐related risk factors after successful renal transplantation …”

Uraemic Cardiomyopathy: A Review of Current Literature

“…Dzemidzić et al have shown that renal transplantation dramatically reduces the proportion of patients with LVH from 67% to 37% with correlations in improved creatinine clearance and in reduction of the serum creatinine values; as well as values of parathyroid hormone. 105 Additionally, Wali et al have shown that 70% of patients with a baseline LVEF <40% prior to renal transplantation, recovered at follow-up at 6 months with LVEF >50% on ventriculography-gated blood pool. Normalization of LVEF was associated with improvement in NYHA class and was the only significant factor associated with reduced hazard for CCF hospitalization and death (RR 0.90).…”

Study of Echocardiographic Changes After Kidney Transplantation in End-stage Renal Disease Patients

“…Wali et al ( 6 ) Kidney transplantation in ESRD patients with advanced systolic heart failure resulted in an increase in LVEF and improved the functional status of congestive heart failure (CHF). Dzemidzic et al ( 18 ) showed that before transplantation, 67% of patients had echocardiographic signs of LVH that after first post-transplant year, 37% of patients remained with LVH (40% reduced). Several studies ( 11 , 14 , 16 , 19 ) reported that after kidney transplantation, there was a reduction of the LVH respect to the pre-transplant dialytic status.…”