Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

Abstract

Background: Data on the cardiorenal syndrome (CRS) in renal transplant recipients (RTR) are scarce. We investigated the prevalence, clinical presentation, treatment, and outcomes of patients with CRS in our renal transplant cohort. Methods: Charts and medical records of adult RTR were investigated to identify patients with renal allograft dysfunction and heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Results: From December 2009 to December 2019, a total of 1,610 patients received a kidney allograft at our institution. CRS was diagnosed in 9 patients (0.56%) a median of 11 years after transplantation (4–20 years). Seven of the patients were male, and 2 were female. The median age when CRS was diagnosed was 71 years (64–80 years). The major presenting symptom was dyspnea. Five patients had HFrEF, and 4 had HFpEF. The patient’s median basal creatinine clearance was 37 mL/min (range 29–77 mL/min). At hospitalization, it was decreased to 24 mL/min (range 13–45 mL/min). The patients were treated with diuretics, but 5 of them required extracorporeal fluid removal. At the 16-month follow-up (median), all patients with HFpEF were alive and had returned to initial levels of creatinine clearance. Two of the 5 HFrEF had died, and 2 needed permanent extracorporeal water removal. Conclusion: CRS after renal transplantation was rare (<1.0%), but CRS in HFreF patients was associated with a poor outcome.