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Published on: October 11, 2014
The Seattle Heart Failure Model in Kidney Transplant Recipients
Angelica Perez-Gutierrez1, Rita L McGill2, Braden Juengel1
1Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA.
Insights
The Seattle Heart Failure Model (SHFM) can predict mortality risk in kidney transplant candidates. An adapted SHFM score effectively identifies patients at higher risk for post-transplant death.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease is the primary cause of death post-kidney transplant.
- Heart failure is prevalent in chronic kidney disease patients, worsening with dialysis duration.
- The Seattle Heart Failure Model (SHFM) predicts heart failure mortality but lacks kidney function parameters.
Purpose of the Study:
- To evaluate the utility of an adapted Seattle Heart Failure Model (SHFM) in predicting post-transplant mortality in end-stage renal disease (ESRD) patients.
- To assess the association between the adapted SHFM score and survival outcomes following kidney transplantation.
Main Methods:
- Retrospective analysis of 360 adult deceased-donor kidney transplant recipients.
- Application of the SHFM to patients with end-stage renal disease (ESRD) prior to transplantation.
- Cox regression modeling to assess the relationship between the adapted SHFM score and post-transplant survival.
Main Results:
- A 1.0-point increase in the adapted SHFM score was significantly associated with increased post-transplant mortality (HR 1.76, p=0.02).
- This association remained significant, independent of Kidney Donor Profile Index and Estimated Post-Transplant Survival.
- Age, sodium, cholesterol, and lymphocyte count were significant individual predictors of mortality.
Conclusions:
- The adapted SHFM score shows promise as a tool for assessing mortality risk in ESRD patients awaiting kidney transplantation.
- Incorporating kidney function assessment into mortality risk models may improve prediction for transplant candidates.
Abstract:
Cardiovascular disease is the leading cause of mortality following kidney transplantation. Heart failure affects 17-21% of patients with chronic kidney disease and increases along with time receiving dialysis. The Seattle Heart Failure Model (SHFM) is a validated mortality risk model for heart failure patients that incorporates clinical, therapeutic, and laboratory parameters but does not include measures of kidney function. We applied the SHFM to patients with end-stage renal disease (ESRD) who were being evaluated for kidney transplantation to determine if the model was associated with post-transplant mortality. This retrospective single-center study analyzed survival among 360 adult deceased-donor kidney transplant recipients. Cox regression was used to model post-transplant patient survival. Our findings indicated that a 1.0-point increase in the adapted SHFM score was significantly associated with post-transplant mortality (HR 1.76, 95% CI = 1.10-2.83, p = 0.02), independently of the Kidney Donor Profile Index and Estimated Post-Transplant Survival. Individual covariates of the SHFM were evaluated in univariate analyses, and age, sodium, cholesterol, and lymphocyte count were significantly related to mortality. This study provides preliminary evidence that an adapted SHFM score could be a useful tool in evaluating mortality risk post-transplant in patients with ESRD.
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