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Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation
Joseph Bayne1, Michael Francke2, Elaine Ma3
1Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Insights
African Americans face a higher risk of chronic kidney disease (CKD) after heart transplants. This study found a significant decline in kidney function and increased CKD development in this population compared to others.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is a common complication after cardiac transplantation, potentially necessitating renal replacement therapy (RRT) or renal transplant.
- African American individuals exhibit a higher predisposition to kidney disease and experience poorer outcomes post-cardiac transplant.
- The specific risk of developing CKD among African Americans following cardiac transplantation remains under-investigated.
Purpose of the Study:
- To investigate the association between African American race and the risk of developing chronic kidney disease (CKD) after cardiac transplantation.
- To compare the rate of estimated glomerular filtration rate (eGFR) decline in African American versus non-African American patients post-cardiac transplant.
- To determine the incidence of CKD and end-stage renal disease (ESRD) requiring RRT at two years post-cardiac transplant based on race.
Main Methods:
- A retrospective study was conducted involving 151 adult patients who underwent single-organ heart transplantation between 2013 and 2016.
- Patients were categorized into African American (n=57) and non-African American (n=94) groups.
- The primary outcomes assessed were a decrease in eGFR, development of CKD, and incidence of ESRD requiring RRT within two years post-transplant.
Main Results:
- African American patients experienced a significantly greater decline in eGFR compared to non-African American patients (-34 ± 6 vs. -20 ± 4 mL/min/1.73 m², p < 0.0006).
- A higher proportion of African American patients developed CKD stage 2 or worse (eGFR < 90 mL/min/1.73 m²) at two years post-transplant (81% vs. 59%, p < 0.0005).
- The findings indicate a statistically significant difference in kidney function decline and CKD development between the two racial groups.
Conclusions:
- This study provides the first evidence that African American patients have a significantly higher risk of eGFR decline and CKD two years after cardiac transplantation.
- The results highlight the critical need for further research into risk-reduction strategies for this vulnerable patient population.
- These findings underscore the importance of vigilant renal function monitoring in African American recipients of cardiac transplants.
Objectives:
This study examined whether African American race was associated with an elevated risk of chronic kidney disease (CKD) post-cardiac transplantation.
Background:
CKD often occurs after cardiac transplantation and may require renal replacement therapy (RRT) or renal transplant. African American patients have a higher risk for kidney disease as well as worse post-cardiac transplant morbidity and mortality. It is unclear, however, if there is a propensity for African Americans to develop CKD after cardiac transplant.
Methods:
The Institutional Review Board of Columbia University Medical Center approved the retrospective study of 151 adults (57 African American and 94 non-African American) who underwent single-organ heart transplant from 2013 to 2016. The primary outcome was a decrease in estimated glomerular filtration rate (eGFR), development of CKD, and end-stage renal disease (ESRD) requiring RRT after 2 years.
Results:
African American patients had a significant decline in eGFR post-cardiac transplant compared to non-African American patients (- 34 ± 6 vs. - 20 ± 4 mL/min/1.73 m2, p < 0.0006). African American patients were more likely to develop CKD stage 2 or worse (eGFR < 90 mL/min/1.73 m2) than non-African American patients (81% vs. 59%, p < 0.0005).
Conclusions:
This is the first study to report that African American patients are at a significantly higher risk for eGFR decline and CKD at 2 years post-cardiac transplant. Future investigation into risk reduction is necessary for this patient population.
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