Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

Abstract

Individuals waiting for a renal transplant experience excessive cardiovascular mortality, which is not fully explained by the prevalence of ischemic heart disease in this population. Overt heart failure is known to increase the mortality of patients with ESRD, but the impact of lesser degrees of ventricular systolic dysfunction is unknown. For examination of the association between left ventricular ejection fraction (LVEF) and mortality of renal transplant candidates, the records of 2718 patients evaluated for transplantation at one institution were reviewed. During 6355 patient-years (median 27 mo) of follow-up, 681 deaths occurred. Patients with systolic dysfunction (LVEF Յ0.40) had significantly lower survival than those with higher systolic function (median 49 Ϯ 3.1 versus 72 Ϯ 4.0 mo; P Ͻ 0.001) but had similar survival to patients with ischemia (48 Ϯ 2.5 mo). Multivariate modeling showed that those with systolic dysfunction were nearly twice as likely to die as those with normal systolic function, adjusted for risk factors including diabetes, left ventricular hypertrophy, and ischemia (adjusted hazard ratio 1.7; 95% confidence interval 1.43 to 2.07). In addition, a graded, reverse association between LVEF and mortality was identified. In conclusion, systolic dysfunction is strongly associated with mortality, in a graded manner, in renal transplant candidates.

QT Prolongation Is an Independent Predictor of Mortality in End‐Stage Renal Disease

“…14 Our prior investigations have revealed that the strongest predictor of survival in ESRD patients is a preserved LVEF. 6,15 In a cohort of 3698 ESRD patients followed for 30 ± 15 months, a depressed LVEF was associated with higher mortality even after adjustments for LVH, myocardial ischemia, diabetes mellitus, and advanced age. 6 Nevertheless, patients with ESRD and a preserved LVEF still have a high mortality rate, suggesting that multiple other factors affect the outcome in these patients.…”

Ischemic Tolerance in Uremic Rabbits

“…Clinical outcomes in patients with chronic kidney disease that suffer an acute myocardial infarction are dismal [27] [28]. Risk of cardiac disease and its associated complications augment in relation to advancing stages of kidney disease [29].…”

Topics in Transplantation Medicine for General Nephrologists

“…Recent reports indicate that pretransplantation congestive heart failure (CHF) predicts mortality postevaluation for transplantation and that CHF may be a consequence of transplantation. While it may not be surprising that patients with CHF do worse than those without, the strength of the association and evidence that relatively modest cardiac dysfunction (ejection fraction of 41% to 50% by SPECT imaging) predicts poor outcomes independent of coronary ischemia heightens the concern for patients with this common problem (22). Because kidney transplantation reestablishes the cardiacrenal axis for management of fluid and solutes, one could hypothesize stabilization of myocardial dysfunction after kidney transplantation.…”