Kidney Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Kidney Transplant, including details on risks, prognosis, procedure, surgery, organ donation.

Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease.

Rakhit DJ, Zhang XH, Leano R, Armstrong KA, Isbel NM, Marwick TH

Department of Medicine, University of Queensland, Brisbane, Australia.

OBJECTIVE: The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD. METHOD: Resting and dobutamine stress echocardiography were used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD. In 129 patients who had normal dobutamine stress echocardiography, myocardial tissue characterization was performed using tissue Doppler imaging and integrated backscatter. Clinical, biochemical, and echocardiographic parameters were recorded at baseline, and patients were followed up for cardiac events and all-cause mortality over 2.4 years. Follow-up echocardiographic and tissue characterization parameters were performed in 80 patients. RESULTS: Previous cardiac history (HR 5.2, P = .002) and serum phosphate (HR 6.2, P = .001) were independent clinical predictors of events (model chi2 = 20.9). Diastolic tissue velocity (HR 0.8, P = .05) was an independent predictor of outcome, and its addition to clinical assessment added incremental prognostic information (model chi2 = 24.8, P < .001). Patients who underwent transplantation (n = 45) showed reduction of wall thickness (P < .001) and LV volumes (P < .001) and increases in diastolic tissue velocity (P = .007) and strain (P = .001), whereas these measurements worsened in those who remained on dialysis. CONCLUSION: In patients with CKD, subclinical LV dysfunction is associated with adverse outcome. Subclinical disease can be improved by transplantation but progresses in patients who continue on dialysis.

Published 26 March 2007 in Am Heart J, 153(4): 656-64.
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