Kidney transplant: a unique cure for severe nonischemic cardiac dysfunction

Cardiovascular complications are the leading cause of mortality among patients with end-stage renal disease, accounting for 50% of all deaths. The prevalence of heart failure amongst these patients is as high as 40% and is responsible for 12% of the total deaths. The mechanisms underlying these cardiac abnormalities remain unclear. Renal transplantation is normally contraindicated. We present a case of a hemodialysis patient with nonischemic severe cardiac dysfunction and chronic poor compliance with salt and water restriction, who demonstrated significant functional and clinical improvement after renal transplantation assessed by echocardiography, cardiac MRI, symptoms and number of hospital admissions. This case highlights the beneficial impact of renal transplantation in a young patient with uncontrollable chronic salt and water overload and nonischemic cardiac dysfunction. Despite the overt clinical and radiological severity in this case, use of scoring systems such as the Northern Regional Risk index demonstrated a low-to-medium risk during transplant assessment. Therefore, individualizing patients during pretransplant assessment and use of scoring systems may assist in further selection of appropriate patients for potential renal transplantation.