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Chronic kidney disease in prevalent orthotopic heart transplant recipients using a new CKD-EPI formula
Piotr Przybylowski1, Jolanta Malyszko, Jacek Malyszko
1Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Cracow, Poland. piotrus@aol.com
Insights
Chronic kidney disease (CKD) is highly prevalent in heart transplant recipients, affecting up to 63.91%. Early evaluation of kidney function is crucial for managing cardiovascular risk in these patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Heart transplantation is a key treatment for advanced heart failure.
- Chronic kidney disease (CKD) is a significant complication post-transplantation, excluding renal transplants.
- A glomerular filtration rate (GFR) below 60 ml/min predicts cardiovascular mortality.
Purpose of the Study:
- To determine the prevalence of kidney dysfunction in heart transplant recipients.
- To evaluate kidney function using the CKD-EPI formula.
- To assess the impact of different formulas on CKD prevalence estimates.
Main Methods:
- A cohort of 169 prevalent heart transplant recipients was studied.
- Kidney function was assessed using serum creatinine and estimated GFR.
- Calculations were performed using Cockcroft-Gault, MDRD, CKD-EPI formulas, and creatinine clearance.
Main Results:
- Mean serum creatinine was 1.71±1.10 mg/dl.
- CKD prevalence varied by formula, with clinically significant CKD (GFR <60 ml/min) ranging from 37.88% to 63.91%.
- The new CKD-EPI formula identified 46.75% of patients with stage 3 CKD.
Conclusions:
- The prevalence of CKD is notably high among heart transplant recipients.
- Renal function assessment is vital for tailoring strategies to mitigate cardiovascular risk.
- The CKD-EPI formula shows promise for accurate kidney function assessment but requires further validation.
Background:
Heart transplantation is an established treatment for advanced heart failure. However, chronic kidney disease (CKD) is an important long-term complication of all forms of organ transplantation other than renal. It has been shown that a GFR <60 ml/min is predictive of premature cardiovascular death.
Material/Methods:
The aim of this study was to assess the prevalence of kidney dysfunction in heart transplant recipients using a new CKD-EPI formula in a cohort of 169 prevalent patients (mean age 53.30+/-13.80 years).
Results:
Mean serum creatinine in this population was 1.71+/-1.10 mg/dl, Serum creatinine was normal (<1.4 mg/dL in males and <1.2 mg/dL in females) in 45.4% of the patients. According to the Cockcroft-Gault formula, stage 2 CKD (i.e.GFR 60-89 ml/min) was demonstrated in 79 patients (46.75%), stage 3 CKD (i.e. GFR 30-59 ml/min) in 49 patients (29.00%) and stage 4 CKD (i.e. GFR 15-29 ml/min) in 15 patients (8.88%). According to MDRD formula stage 2 CKD was found in 36 patients (21.30%), stage 3 CKD was found in 79 patients (46.75%) and stage 4 in 27 patients (15.98%). According to new CKD-EPI formula, stage 2 CKD was found in 35 patients (20.71%), stage 3 CKD in 79 patients (46.75%) and stage 4 in 28 patients (16.57%). According to the creatinine clearance stage 2 CKD was found in 61 patients (36.09%), stage 3 CKD in 63 patients (37.28%) and stage 4 in 19 (11.24%) patients. Clinically significant CKD (GFR <60 ml/min) was found in 37.88-63.91% depending on the formula used to estimate the GFR. Normal kidney function was found in 27 patients (15.98%) according to MDRD formula, in 27 patients (15.98%) according to new CKD-EPI formula, in 26 patients (15.38%) according Cockcroft-Gault formula and 26 patients (15.38%) on the basis of 24-hours creatinine clearance.
Conclusions:
We conclude that the prevalence of CKD is high in heart transplant recipients. Evaluation of renal function is important in order to select the appropriate strategy to reduce the cardiovascular risk. New CKD-EPI formula seems to more accurate in assessment kidney function that previously used, however, it merits further studied and validation against gold standard of isotope GFR measurement.
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