Association of Left Atrial Volume With Mortality Among ESRD Patients With Left Ventricular Hypertrophy Referred for Kidney Transplantation

Patel, Rajan K.; Mark, Patrick B.; Cunningham, Adam F.; Steedman, Tracey; Powell, Joanna R.; McQuarrie, Emily P.; Stevens, Kate; Dargie, Henry J.; Jardine, Alan G.

doi:10.1053/j.ajkd.2009.12.033

Cited by 58 publications

(54 citation statements)

References 34 publications

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“…23,24 Left atrial volume also displays additional prognostic value beyond that provided by other Heart Disease in Kidney Disease echocardiographic parameters in dialysis patients. [25][26][27] Thus, in keeping with earlier cross-sectional studies that showed greater impairment of diastolic function than systolic function in patients with CKD who were not undergoing dialysis, 28,29 our longitudinal study demonstrated that more advanced CKD stages at baseline were associated with more deterioration in diastolic function over time but not systolic function. Our observations provide important novel insights into the nature of structural and functional changes of the myocardium with CKD progression.…”

Section: Discussionsupporting

confidence: 86%

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

Cai¹,

et al. 2014

Journal of the American Society of Nephrology

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Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imagingderived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index CKD is a global public health problem and a major risk factor for cardiovascular disease. 1,2 Cardiovascular mortality is estimated to be at least 10-to 100-fold higher in patients with ESRD than in the age-, race-, and sex-matched general population. 2 This higher mortality is attributed to an increased risk of developing accelerated atherosclerosis, vascular calcification, heart failure, and sudden cardiac death. 3 Even earlier stages of CKD are associated with an increased cardiovascular risk. 1,4,5 Of the various cardiovascular complications, left ventricular hypertrophy (LVH) is one of the most prevalent 6,7 and is predictive of an increased mortality and cardiovascular death. 8,9 More than 75% of patients with CKD already had established LVH at the time of dialysis initiation. 10 The prevalence of LVH in patients with CKD who are not undergoing dialysis was lower, ranging from 32% to 75%. 6,7,11,12 Notably, patients with an eGFR,30 ml/min per 1.73 m 2 showed a .2-fold increased risk of having LVH compared with those with an eGFR$60 ml/min per 1.73 m 2 , 6 suggesting that worsening kidney function or uremia, per se, may be an important contributing factor for LVH in CKD. Indeed, several previous cross-sectional studies have consistently shown an important inverse relationship between eGFR and left ventricular (LV) mass

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Section: Discussionsupporting

confidence: 86%

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

Cai¹,

et al. 2014

Journal of the American Society of Nephrology

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“…31,32 Furthermore, whether through the predisposition to AF or as a marker of chronic LV diastolic impairment, recent evidence confirms an association between LA dilatation and increased mortality in ESRF patients with LV hypertrophy. [32][33][34] Our study would support the conclusion that changes in atrial dimension following AVF-creation may play a significant role in the promotion of atrial arrhythmia within the ESRF milieu.…”

supporting

confidence: 75%

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Dundon¹,

Torpey²,

Nelson³

et al. 2014

IJNRD

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Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in endstage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via "gold standard" imaging techniques in the modern era of end-stage renal failure care. Methods: A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. , and left ventricular mass were observed (12.7% increase) (P,0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion:In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.

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“…This finding is in concordance with the results found by Patel et al (4) in dialysis patients with LVH. Patel et al (4) divided the measured left atrial volume into quartiles and found higher quartiles with higher mortality.…”

Section: Discussionsupporting

confidence: 94%

“…Although the annual rate of cardiac death of dialysis patients decreases from roughly 5% to 2% after successful transplantation, it remains the main cause of mortality (1). Prominent risk factors in patients on dialysis are left ventricular hypertrophy, left ventricular dysfunction, and left atrial enlargement (2)(3)(4). It has been shown that structural and functional improvements of echocardiographic parameters occur after transplantation, but it remains elusive whether baseline echocardiographic measures remain predictors of mortality (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Diameter and Survival among Renal Allograft Recipients

Kainz

Goliasch

Wiesbauer

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor-and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation.Design, setting, participants, & measurements This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death.Results During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P,0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P,0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001). ConclusionThe left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.

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Association of Left Atrial Volume With Mortality Among ESRD Patients With Left Ventricular Hypertrophy Referred for Kidney Transplantation

Cited by 58 publications

References 34 publications

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Left Atrial Diameter and Survival among Renal Allograft Recipients

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