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Differences in cardiac structure assessed by echocardiography between renal transplant recipients and chronic kidney
E Dounousi1, M Mitsis1, K K Naka2
1Renal Transplant Unit, University Hospital of Ioannina, Ioannina, Greece.
Insights
Renal transplant recipients (RTRs) show significantly lower left ventricular mass index (LVMI) compared to predialysis chronic kidney disease (CKD) patients. This suggests improved cardiac structure after kidney transplantation.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is a major cause of mortality in chronic kidney disease (CKD) and renal transplant recipients (RTRs).
- Left ventricular hypertrophy (LVH), a predictor of CVD, develops early in CKD.
- Data comparing cardiac structure between predialysis CKD patients and RTRs is limited.
Purpose of the Study:
- To compare echocardiographic measurements of left ventricular (LV) structure and function between predialysis CKD patients and RTRs.
- To assess LV mass index (LVMI) in relation to renal function.
Main Methods:
- A case-control study matched 36 RTRs with 72 predialysis CKD patients (1:2 ratio) based on age, gender, and eGFR.
- Transthoracic echocardiography was used to measure LV mass, LVMI, and systolic function.
- LVMI was retrospectively analyzed at predialysis, dialysis, and post-transplant stages in a subgroup of 12 RTRs.
Main Results:
- The prevalence of LVH was 52% in CKD patients versus 33% in RTRs.
- RTRs exhibited significantly lower LVM and LVMI compared to predialysis CKD patients (P = .006 and P = .008).
- Post-transplant LVMI in RTRs (105 ± 25 g/m²) was significantly lower than predialysis (147 ± 57 g/m²) and dialysis (169 ± 72 g/m²) levels (P = .01 for both).
Conclusions:
- RTRs demonstrate significantly reduced LVMI compared to predialysis CKD patients with similar demographics and clinical parameters.
- Successful renal transplantation may lead to regression of left ventricular hypertrophy.
Background:
Cardiovascular disease (CVD) is the leading cause of death in predialysis chronic kidney disease (CKD) and dialysis patients as well as in renal transplant recipients (RTRs). Left ventricular hypertrophy (LVH) starts early during the course of CKD and is a strong predictor of CVD in this population. Regression of LVH after a successful renal transplantation remains a debatable issue among investigators, whereas there is little data comparing echocardiographic measurements between patients with predialysis CKD and RTRs.
Aim:
The aim of this study was to compare echocardiographic measurements of LV structure and function between predialysis CKD patients and RTRs of similar renal function level.
Patients And Methods:
We conducted a case control study with individual (1:2) matching from the Renal Transplant and the predialysis CKD Outpatient Clinic. For each of the 36 RTRs, two matched for gender, age and estimated glomerular filtration rate (eGFR) predialysis CKD outpatients (72 patients) were included. All patients underwent transthoracic echocardiography and LV mass, LV mass index [LVM and LVMI = LVM/BSA g/m(2)] and indices of systolic function were measured. In a subgroup of 12 RTRs we retrospectively assessed and compared the LVMI measurements at three different time points, during predialysis, dialysis and post transplant period.
Results:
The prevalence of LVH was 33% in RTRs and 52% in CKD patients (ns). RTRs had significantly lower LVM and LVMI levels compared with predialysis CKD patients (P = .006 and P = .008) while the other echocardiographic indices did not differ. In the subgroup of 12 RTRs, post-transplant LVMI levels (105 ± 25 g/m(2)) were significantly lower in comparison with predialysis (147 ± 57 g/m(2)) and dialysis LVMI levels (169 ± 72 g/m(2)) (P = .01, P = .01, respectively).
Conclusion:
RTRs had significantly lower LVMI compared with predialysis CKD patients of similar age, renal function, hemoglobin and blood pressure level.
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