Abstract
Cardiovascular diseases (CVD) are a major cause of morbidity and leading cause of mortality in almost 50% of patients (pts) with chronic kidney disease (CKD), including kidney transplant recipients. Left ventricular hypertrophy (LVH) is the most common structural alteration and powerful risk factor for cardiovascular complications in the uremic patients. The aim of this study is to analyze predictors of the left ventricular remodelling in the first year after kidney transplantation based on comparison of echocardiographic findings, which had been done before and twelve months after transplantation. In five years retrospective study, we followed up 30 kidney transplant patients in the first post-transplant year. All patients data - blood pressure, BMI, ECG, blood haemoglobin, serum protein, calcium, phosphorus, product of calcium and phosphorus, the values of parathyroid hormone, serum creatinine and creatinine clearance were recorded just before kidney transplantation and in one month interval after transplantation in the first post-transplant year. Echocardiographic examination was done before transplantation and one year after kidney transplantation. Before transplantation, 33% of patients had normal echocardiographic finding and 67% of patients had echocardiographic signs of left ventricular hypertrophy. After first post-transplant year, 63% of patients showed normal echocardiographic finding of LV, while 37% of patients remained with LV hypertrophy. Diastolic dysfunction of LV until the end of study had been reduced in 40% of pts compared to 70% pts at the beginning of the study. The positive echocardiographic remodelling of LV significantly correlated with rising values of haemoglobin (p<0.05), creatinine clearance (p=0.039) and with the reduction of the serum creatinine values (p=0.047), as well as values of parathyroid hormone (p=0.022). These results confirmed positive relationship between echocardiographic remodelling of left ventricular hypertrophy and elimination uraemia-related risk factors after successful renal transplantation.
Highlights
Uraemic cardiomyopathy, defined as left ventricular hypertrophy (LVH), left ventricular dilatation or left ventricular systolic dysfunction, is reported to be a predictor of cardiovascular morbidity and mortality in patients with end-stage of renal disease
A large number of traditional and non-traditional uraemia related risk factors independently predict the risk of cardiovascular outcome, even among the patients with less degrees of renal failure ( ). e certain interplay between kidney and cardiovascular disease suggests synergistic effect whereby advancing kidney failure promotes cardiovascular complications and vice versa in bi-direction relationship
Logistical regression was used to test the independent relationship between left ventricular mass index and potential predictors: blood haemoglobin, serum protein, calcium, phosphorus, product of calcium and phosphorus, the values of parathyroid hormone, serum creatinine and creatinine clearance
Summary
Uraemic cardiomyopathy, defined as left ventricular hypertrophy (LVH), left ventricular dilatation or left ventricular systolic dysfunction, is reported to be a predictor of cardiovascular morbidity and mortality in patients with end-stage of renal disease. As an adaptive response to volume and pressure overload, remains the prevalent form of cardiomyopathy in the patients with end-stage renal disease, including renal transplant patients ( - ) ( , ). A large number of traditional and non-traditional uraemia related risk factors independently predict the risk of cardiovascular outcome, even among the patients with less degrees of renal failure ( ). Some recently published studies emphasize that the identification of modifiable cardiovascular risk factors may enable reduction risk of cardiovascular morbidity in renal transplant recipient ( ). We hypothesized that some risk factors could independently predict the course and outcome of left ventricular remodelling in the first post-transplant year. The objective of this study was to determine the prevalence of LVH and prognostic impact of follow-up risk factors on LV remodelling in the first year after transplantation. Investigation was made by the comparison of echocardiographic findings made before and twelve months after transplantation
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