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Renal transplantation. Effect on the ischemic heart disease of essential malignant hypertension
Insights
Kidney transplants for essential hypertension do not stop heart disease progression. Patients with existing coronary artery disease may benefit more from dialysis than transplantation.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Essential hypertension is a common cause of end-stage renal disease.
- Coronary artery disease (CAD) is a significant comorbidity in patients with hypertension and renal failure.
Purpose of the Study:
- To evaluate the impact of cadaveric renal transplantation on the progression of coronary artery disease in patients with essential hypertension.
- To determine optimal management strategies for renal failure patients with pre-existing ischemic heart disease.
Main Methods:
- Retrospective analysis of 204 consecutive cadaveric renal allograft recipients.
- Identification of patients with essential hypertension as the primary diagnosis for renal failure.
- Clinical follow-up to assess cardiac events post-transplantation.
Main Results:
- Fourteen recipients (6.8%) had essential hypertension as the primary diagnosis.
- Four of these patients had pre-existing ischemic heart disease.
- Three patients died from myocardial infarction within 31 months post-transplantation; one experienced coronary insufficiency.
Conclusions:
- Cadaveric renal transplantation does not halt the progression of coronary artery disease in patients with hypertension-induced renal failure.
- Renal failure patients with angina or prior myocardial infarction may be better served by maintenance hemodialysis instead of transplantation.
Abstract:
In 14 of 204 consecutive cadaveric renal allograft recipients, the primary diagnosis was essential hypertension. Four patients had manifest ischemic heart disease before transplantation. Three of these patients died within 31 months of transplantation from recurrent myocardial infarction, and the fourth experienced coronary insufficiency. Cadaveric renal transplantation does not prevent the progression of coronary artery disease in patients whose renal failure was due to essential hypertension. In the presence of angina or previous myocardial infarction, these patiemts may be better treated by maintenance hemodialysis.