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Impact of renal transplantation on uremic cardiomyopathy
P S Parfrey1, J D Harnett, R N Foley
1Division of Nephrology, Health Sciences Centre, Newfoundland, Montreal, Canada.
Insights
Renal transplantation significantly improves uremic cardiomyopathy in end-stage renal disease (ESRD) patients. Successful kidney transplants normalize heart function, reduce left ventricular hypertrophy, and improve dilated cardiomyopathy, benefiting dialysis patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Chronic uremia in end-stage renal disease (ESRD) patients commonly leads to uremic cardiomyopathy, characterized by systolic dysfunction, left ventricular (LV) hypertrophy, or LV dilatation.
- Uremic cardiomyopathy significantly contributes to morbidity and mortality in ESRD patients undergoing dialysis.
Purpose of the Study:
- To evaluate the impact of successful renal transplantation on the cardiac structure and function of dialysis patients with uremic cardiomyopathy.
- To assess the potential benefits of kidney transplantation for improving cardiac outcomes in ESRD patients.
Main Methods:
- A long-term cohort study followed 102 ESRD patients who received successful renal transplants, using echocardiography to assess cardiac parameters before and after transplantation.
- Compared cardiac function and structure in transplanted patients with pre-transplant conditions and overall ESRD cohort characteristics.
Main Results:
- Following renal transplantation, 12% of patients with pre-existing systolic dysfunction showed normalized fractional shortening (21.5% to 33.5%).
- 41% of patients with concentric LV hypertrophy experienced improved LV mass index (158 to 132 g/m2).
- 32% of patients with LV dilatation showed reduced LV volume (116 to 89 ml/m2) and LV mass index (166 to 135 g/m2).
Conclusions:
- Renal transplantation effectively corrects uremic cardiomyopathy, leading to normalization of LV contractility, regression of hypertrophy, and improved cavity volume.
- These findings suggest that dialysis patients with uremic cardiomyopathy would significantly benefit from renal transplantation.
Abstract:
In chronic uremia, cardiomyopathy manifests itself as systolic dysfunction, concentric left ventricular (LV) hypertrophy, or LV dilatation. To determine the impact of renal transplantation on uremic cardiomyopathy, all dialysis patients participating in a long-term cohort study who received a successful renal transplant were followed with echocardiography. The transplanted group comprised 102 of 433 (24%) endstage renal disease (ESRD) patients. They were significantly younger and, on starting ESRD therapy, had significantly less ischemic heart disease and cardiac failure than the overall ESRD cohort. During followup, ischemic heart disease developed in only 1 patient and none experienced cardiac failure. In the 12% (n = 12) of patients with systolic dysfunction before renal transplant, fractional shortening normalized in all patients, increasing from 21.5 +/- 4.6% to 33.5 +/- 5.6% after transplantation. In the 41% (n = 41) with concentric LV hypertrophy before transplantation, the LV mass index improved from 158 +/- 39 g/m2 to 132 +/- 39 g/m2. LV dilatation was present in 32% (n = 32) of patients before transplantation. After transplantation, LV volume fell from 116 +/- 3.1 ml/m2 to 89 +/- 21 ml/m2, and LV mass index in this group fell from 166 +/- 55 g/m2 to 135 +/- 37 g/m2. It was not possible to associate risk factors characteristic of the uremic state with the improvement in cardiac structure and function, although the fall in LV mass was significantly associated with fall in blood pressure. We conclude that correction of the uremic state by renal transplantation leads to normalization of LV contractility in systolic dysfunction, regression of hypertrophy in concentric LV hypertrophy, and improvement of cavity volume in LV dilatation. The degree of improvement suggests that dialysis patients with uremic cardiomyopathy would benefit from renal transplantation.