Abstract
Renal transplantation is the optimal approach to management of patients with terminal end-stage renal failure (ESRF). The leading position in the mortality structure of recipients of kidney transplants belongs to cardiovascular disorders. The review analysis the causes and the role of arterial hypertension, myocardial hypertrophy, congestive heart failure, coronary artery disease, and dyslipidemia at different stages of chronic kidney disease (the initial pre-dialysis stage, the hemodialysis or peritoneal dialysis stage, and the post-transplant stage), as well as the possibilities of management of cardiovascular complications. Despite the fact that a successful transplantation would lead to restoration of the renal function, the prevalence of post-transplant arterial hypertension remains significant and continues to be a major prognostic factor. Arterial hypertension in ESRF patients triggers myocardial and chamber remodeling, mediated by left ventricular hypertrophy. Left ventricular hypertrophy progression due to fibrotic proliferation underlies the systolic and diastolic dysfunction, as well as electrical instability of the myocardium, which leads to such clinical conditions as heart arrhythmias and congestive heart failure. The development of congestive heart failure in transplant recipients has been recognized as an unfavorable prognostic factor. The high prevalence of coronary artery disease among the kidney recipients is related to such risk factors as left ventricular hypertrophy, decreased myocardial contractility, anemia, hypertension, and diabetes mellitus. Screening for coronary artery disease in patients with ESRF awaiting for transplantation, with subsequent preventive revascularization, may reduce perioperative risks of adverse cardiovascular events and improve long-term results of transplantation. Disorders of lipid metabolism related to ESRF are an independent risk factor for coronary atherosclerosis and coronary artery disease. Even after a successful renal transplantation, dyslipidemia remains a significant problem with its specific characteristics. In addition to its effect on cardiovascular morbidity, the lipid disorders can deteriorate renal function. Identification of potentially reversible risk factors for cardiovascular events and their early management are a key strategy that determines the life longevity and quality of life in renal transplant recipients. A thorough screening for risk factors in this patient category is necessary to optimize their management.
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