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Cardiovascular Functional Reserve Before and After Kidney Transplant
Kenneth Lim1, Stephen M S Ting2, Thomas Hamborg3
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.
JAMA Cardiology
|February 6, 2020
Summary
Kidney transplant improves cardiovascular functional reserve in patients with end-stage renal disease, as measured by maximum oxygen consumption (V̇O2max). Wait-listed patients showed a decline, highlighting the benefits of transplantation.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Kidney transplant improves survival in end-stage renal disease (ESRD).
- Previous studies on cardiovascular survival post-transplant used static measures with conflicting results.
- Objective quantification of cardiovascular functional reserve is needed.
Purpose of the Study:
- To evaluate cardiovascular functional reserve in ESRD patients before and after kidney transplant.
- To assess functional and morphologic alterations in structural-functional dynamics post-transplant.
Main Methods:
- Prospective, nonrandomized, controlled cohort study (CAPER study).
- Included kidney transplant recipients (KTR), non-transplant wait-listed (NTWC), and hypertension (HTC) groups.
- Cardiopulmonary exercise testing (CPET) and echocardiography used to quantify cardiovascular functional reserve.
Main Results:
- CKD patients (KTR, NTWC) had lower V̇O2max and higher left ventricular mass index than HTC.
- Kidney transplant (KTR) significantly improved V̇O2max and left ventricular ejection fraction at 12 months post-transplant.
- V̇O2max decreased in wait-listed (NTWC) patients over 12 months.
Conclusions:
- Kidney transplant is associated with improved cardiovascular functional reserve 1 year post-transplant.
- CPET is sensitive in detecting declines in cardiovascular reserve in CKD patients.
- Improved V̇O2max may relate to ultrastructural changes post-uremia reversal.
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