Reversal of Left Ventricular Dysfunction after Renal Transplantation

Burt, Richard K.; Gupta-Burt, Shalina; Suki, Wadi N.; Barcenas, Camilo G.; Jj, Ferguson; Buren, Charles T. Van

doi:10.7326/0003-4819-111-8-635

Cited by 90 publications

(35 citation statements)

References 17 publications

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“…7,30 Studies demonstrating improvements in cardiac function after renal transplantation in patients with primary kidney disease suggest that renal insufficiency may be more than a marker for heart failure severity and instead may play a causative role in the progression of heart failure. 31 For example, renal insufficiency is associated with multiple changes in vascular pathobiology that may worsen cardiovascular outcomes, including abnormalities in the coagulation/fibrinolytic systems, abnormal vascular calcification (due to elevated calcium-phosphorus products), endothelial dysfunction, hyperhomocystinemia, insulin resistance, elevated levels of C-reactive protein, disruptions in the endothelin/nitric oxide balance, electrolyte perturbations predisposing to arrhythmias, and hyperactivation of the sympathetic nervous and renin-angiotensin systems. 32 Finally, because renal blood flow is affected proportionally to a greater extent than cardiac output in systolic failure, it is entirely plausible that creatinine clearance would be a better indicator of functional capacity than any other clinical or laboratory signs.…”

Section: Discussionmentioning

confidence: 99%

Renal Insufficiency and Heart Failure

et al. 2004

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Background-The prevalence, prognostic import, and impact of renal insufficiency on the benefits of ACE inhibitors and ␤-blockers in community-dwelling patients with heart failure are uncertain. Methods and Results-We analyzed data from a prospective cohort of 754 patients with heart failure who had ejection fraction, serum creatinine, and weight measured at baseline. Median age was 69 years, and 43% had an ejection fraction Ն35%. By the Cockcroft-Gault equation, 118 patients (16%) had creatinine clearances Յ30 mL/min and 301 (40%) had creatinine clearances between 30 and 59 mL/min. During follow-up (median 926 days), 385 patients (37%) died. Even after adjustment for all other prognostic factors, survival was significantly associated with renal function (Pϭ0.002) in patients with either systolic or diastolic dysfunction; patients exhibited a 1% increase in mortality for each 1-mL/min decrease in creatinine clearance. in patients with creatinine clearances Ͻ60 mL/min versus Ն60 mL/min, although these drugs were used less frequently in patients with renal insufficiency. Conclusions-Renal insufficiency is more prevalent in patients with heart failure than previously reported and is an independent prognostic factor in diastolic and systolic dysfunction. ACE inhibitors and ␤-blockers were associated with similar reductions in mortality in patients with and without renal insufficiency.

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Section: Discussionmentioning

confidence: 99%

Renal Insufficiency and Heart Failure

et al. 2004

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“…Patients with CRF frequently have complications such as hypertension, myocardial hypertrophy, decreased left ventricular contractility, or dialysis-induced hypotension which may be associated with cardiac autonomic nervous system abnormalities [1, 4, 5, 6]. However, the clinical characteristics of the cardiac autonomic nervous system have not been well described in patients with CRF on dialysis.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Autonomic Neuropathy in Patients with Chronic Renal Failure on Hemodialysis

Kurata¹,

Uehara²,

Sugi³

et al. 2000

Nephron

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To characterize uremic cardiac autonomic neuropathy, we measured plasma catecholamines, analyzed the 24-hour heart rate variability (HRV), and acquired serial images with ¹²³I-metaiodobenzylguanidine (MIBG) in 44 patients with chronic renal failure on hemodialysis and in 14 controls. Time-domain measures were calculated using the Marquette HRV program. MIBG clearance rates from the heart and lung were evaluated on planar images, and the regional MIBG uptake in the left ventricular myocardium was evaluated with single-photon emission computed tomography. Compared with controls, plasma dopamine and norepinephrine levels were elevated (p < 0.001 and p = 0.03, respectively), and all the time-domain measures of HRV were reduced in the patients (p < 0.001). The MIBG clearance rate from the heart was higher (p < 0.001), that from the lung was lower (p < 0.001), and the myocardial MIBG distribution was more heterogeneous in patients than in controls (total uptake score p ≤ 0.03). These variables were similar between 26 patients without and 18 patients with hypertension. Uremic cardiac autonomic neuropathy may be characterized by high plasma levels of dopamine and norepinephrine, reduced HRV, and abnormal MIBG kinetics in the heart with heterogeneous myocardial MIBG distribution, suggesting cardiac sympathetic overactivity and parasympathetic deterioration. In addition, abnormal MIBG kinetics in the lung may imply pulmonary sympathetic nervous dysfunction and/or endothelial dysfunction in uremic patients.

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“…In 1989, Burt et al [2] described a series of 4 patients with ESRD who had left ventricular dysfunction with decreased LVEF and who underwent renal transplantation, with a subsequent increase in LVEF. Wali et al [3], studying a cohort of 103 patients with LVEF ≤40% undergoing renal transplantation, showed normalization of LVEF in 69.9% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…We report on a case of an ESRD patient with decreased left ventricular ejection fraction (LVEF) that increased after renal transplantation [2]. …”

Section: Introductionmentioning

confidence: 99%

Partially Reversible Cardiomyopathy after Renal Transplant Associated with Anti-Troponin I Antibodies

et al. 2013

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Cardiomyopathy associated with dialysis has been shown to be reversible in some cases. A 58-year-old female patient with polycystic renal disease and end-stage renal disease had a renal transplant after 9 years on hemodialysis. Dilated cardiomyopathy with depressed left ventricular ejection fraction markedly improved after transplantation, with normalization of the ejection fraction. High titers for anti-troponin I antibodies were measured: IgG 1:640, IgM 1:80. In our case, the presence of anticardiac (anti-troponin I) antibodies may suggest that the syndrome of reversible cardiomyopathy seen after renal transplantation is associated with immunosuppression therapy acting on immunological mechanisms previously at play.

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Reversal of Left Ventricular Dysfunction after Renal Transplantation

Cited by 90 publications

References 17 publications

Renal Insufficiency and Heart Failure

Renal Insufficiency and Heart Failure

Cardiac Autonomic Neuropathy in Patients with Chronic Renal Failure on Hemodialysis

Partially Reversible Cardiomyopathy after Renal Transplant Associated with Anti-Troponin I Antibodies

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