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Impact of Different Approaches to Kidney Transplant with and without Chronic Hemodialysis on Cardiac Function and
Marta Obremska1, Dorota Kamińska2, Magdalena Krawczyk1
1Department of Cardiovascular Imaging, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Borowska 213, Poland.
Insights
Preemptive kidney transplant (KTx) without prior hemodialysis offers significant cardiovascular benefits for end-stage renal disease patients. This approach reduces cardiac damage and improves heart function compared to KTx after chronic hemodialysis.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- End-stage renal disease (ESRD) patients face elevated cardiovascular risks.
- Preemptive kidney transplant (KTx) is linked to better survival and quality of life.
- The impact of prior chronic hemodialysis on cardiovascular health post-KTx requires further investigation.
Purpose of the Study:
- To compare the cardiovascular benefits of preemptive KTx with and without prior chronic hemodialysis.
- To assess cardiac morphological and functional differences between these two KTx approaches.
Main Methods:
- A case-control study involving 21 patients undergoing preemptive KTx without prior hemodialysis and 21 matched controls who received hemodialysis before KTx.
- Echocardiography was used to evaluate cardiac morphological and functional parameters.
Main Results:
- Patients receiving preemptive KTx without prior hemodialysis exhibited less cardiac damage.
- Key indicators of reduced cardiac damage included higher global longitudinal strain, peak atrial and contractile strain, and early diastolic mitral annular velocity.
- These patients also showed a lower left ventricular mass, left atrial volume index, and mitral inflow velocity ratio.
Conclusions:
- Chronic hemodialysis prior to KTx is an independent determinant of adverse post-transplant cardiac remodeling.
- Preemptive KTx without prior hemodialysis is a preferred strategy for ESRD patients, mitigating cardiovascular risks.
- Findings support optimizing KTx timing to improve long-term cardiovascular outcomes in ESRD.
Abstract:
Patients with end-stage renal disease have higher cardiovascular morbidity and mortality compared with the general population. Preemptive kidney transplant (KTx) has been shown to be associated with improved survival, better quality of life, lower healthcare burden, and reduced cardiovascular risk. In this case-control study, we investigated the cardiovascular benefits of two approaches to KTx: with and without previous chronic hemodialysis. We enrolled 21 patients who underwent preemptive KTx and 21 matched controls who received chronic hemodialysis before KTx. Cardiac morphological and functional parameters were assessed by echocardiography. Overall, patients undergoing preemptive KTx showed less extensive cardiac damage compared with controls, as evidenced by higher global longitudinal strain, peak atrial and contractile strain, and early diastolic mitral annular velocity as well as a lower left ventricular mass, left atrial volume index, and the ratio of mitral inflow early diastolic velocity to the mitral annular early diastolic velocity. In the multivariable analysis, the presence of chronic hemodialysis prior to KTx was an independent determinant of post-transplant cardiac functional and structural remodeling. These findings may have important clinical implications, supporting the use of preemptive KTx as a preferred treatment strategy in patients with end-stage renal disease.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
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01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention