Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010

Abstract

SUMMARYWe aimed to study the incidence, predictors and outcome of chronic kidney disease (CKD) after heart transplantation (HT). All our HT patients 1988-2010 were considered for inclusion. Of these, 134 came for annual follow-ups including evaluation of glomerular filtration rate (GFR) using iohexol clearance measurements, and the CKD-EPI (adults) or Schwartz (children) formulae. Median GFR (Q1-Q3) (ml/min/1.73 m 2 ) declined from 67.0 (50.0-82.0) during transplant assessment (TA) to 56.0 (45.0-69.0) at year 1, 53.0 (41.0-68.0) at year 5 and 44.5 (25.0-57.3) at year 10. The cumulative incidence of CKD ≥ stage 4 was 25% at 5 years and 41% at 10 years after transplantation. Proteinuria the first year post-HT was the only predictor related (P < 0.05) to a higher rate of GFR decline (HR 5.15, 95% CI 1.23-21.55). GFR ≥60 as compared to <60 before HT, or a firstyear GFR decline <30% as compared to >30%, was moreover associated (P < 0.05) with a lower risk of death (HR 0.30, respectively). Notably, the CKD-EPI and Schwartz formulae overestimated GFR by 28 AE 29% and 26 AE 33%, respectively. In conclusion, CKD in HT patients is common and associated with worse outcome. To avoid diagnostic delay, GFR estimating equations' validity in HT patients needs further study.

Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls

“…Interestingly, the renal function in our patients remained stable during post HTx follow-up, and did not worsen over time as previously reported. 25,26 This is in line with a recent publication from our centre showing a stabilization of renal function after HTx during the latest era (2012-2018). 27 Notably, a higher proportion of control patients was treated with everolimus combined with a low dose calcineurin inhibitors as a renal sparing protocol.…”

Plasma Biomarkers for Clinical Assessment of Bone Mineral Density in Heart Transplanted Patients—A Single-Center Study at Skåne University Hospital in Lund

“…In addition, FGF23 levels are also known to increase in relation to progression of kidney dysfunction, which is common in HT candidates [ 25 ]. In a previous study at our center, it was concluded that the occurrence of kidney dysfunction, measured by iohexol clearance, increased over time after HT, reaching 25% with CKD stage ≥4 by the fifth post-operative year [ 26 ]. It is furthermore known that DXA from the lumbar spine might be overestimated in cases of vascular calcification, which is a common feature in patients with chronic kidney disease [ 27 , 28 ].…”

Association of Whole Blood Tacrolimus Concentrations with Kidney Injury in Heart Transplantation Patients

“…AKI persistent at 1 month after transplantation has been shown to significantly decrease survival rates compared to patients with complete renal recovery [ 1 , 10 , 13 , 28 ]. Moreover, earlier reports showed a steady increase in the percentage and severity of CKD after heart transplantation in the first 10 years with a median time to progression to CKD stage 4 of 3 years [ 1 , 9 ]. Hence, the importance of AKI in the development of CKD shows to be pivotal and tacrolimus may have an important part in it.…”

“…Plasma creatinine in heart transplantation patients shortly after surgery may overestimate renal function [ 47 ]. Moreover, CKD-EPI tends to overestimate GFR [ 9 ]. Uniformity in defining kidney injury as well as recovery from AKI may be an important improvement for the comparison of renal outcome in heart transplant recipients.…”

“…Of these patients, 81% has been treated with the immunosuppressant tacrolimus as the preferred calcineurin inhibitor [ 6 ]. It has been acknowledged that CKD after heart transplantation contributes considerably to increasing mortality rates over time [ 7 – 9 ]. Logically, prevention of acute kidney injury (AKI) might prevent subsequent CKD in heart transplants [ 10 ].…”