Effects of Reduced Kidney Function Because of Living Kidney Donation on Left Ventricular Mass

Altmann, Ursula; Böger, Carsten A.; Farkas, S.; Mack, Matthias; Luchner, Andreas; Hamer, Okka W.; Zeman, Florian; Debl, Kurt; Fellner, Claudia; Jungbauer, Carsten; Banas, Bernhard; Büchner, Stefan

doi:10.1161/hypertensionaha.116.08175

Cited by 15 publications

(17 citation statements)

References 42 publications

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“…Altmann et al . also showed increased left ventricular mass after 1 year while Kasiske et al . demonstrated that uric acid and PTH was increased 3 years after nephrectomy.…”

Section: Discussionmentioning

confidence: 90%

“…Three different studies have addressed different surrogate markers for cardiovascular disease after kidney donation . In these studies the donors were normotensive at the time of nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that hypertension in the general population is associated with cardiovascular morbidity and mortality and these risks are even more pronounced in patients with chronic renal disease . Short‐term studies using surrogate endpoints have indicated that live donors are susceptible to an increase in diverse cardiovascular risk factors after donor nephrectomy .…”

Section: Introductionmentioning

confidence: 99%

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Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

et al. 2019

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In the general population, small increases in blood pressure are associated with increased mortality. In kidney donors this association is less certain. We therefore assessed long-term overall and cardiovascular mortality in donors who were hypertensive at the time of donation compared with normotensive donors. Hypertension was defined as blood pressure >140/90 mmHg or use of antihypertensive drugs. Adequate records available in 2131 donors revealed that 140 were hypertensive and 1991 were normotensive. Multivariable regression analyses were performed for overall and cardiovascular mortality. Hypertensive donors were significantly older (mean 57.7 vs. 46.9 years), more were males (44.3% vs. 41.5%), had higher body mass index (26.4 vs. 24.7) and lower estimated glomerular filtration rate (91.8 vs. 101.2 ml/min/1.73 m 2 ). After a median observation time of 20.8 years (interquartile range 11) 71 hypertensive donors had died and 26 of the deaths were cardiovascular. Multivariable analysis did not suggest a generalizable association between hypertension and long-term overall mortality [hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.9-1.5, P = 0.34] or cardiovascular mortality (HR 1.1, 95% CI 0.7-1.8, P = 0.55). These data may support the use of older healthy kidney donors with hypertension at donation. Transplant International 2019; 32: 960-964

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“…Altmann et al . also showed increased left ventricular mass after 1 year while Kasiske et al . demonstrated that uric acid and PTH was increased 3 years after nephrectomy.…”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

et al. 2019

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“…This may be because there is no renal cortical damage or ischemia in kidney donors; the circulating renin-angiotensin system is probably not activated. 4 , 5 This lack of association between living kidney donors and increased risk of HTN benefits studies investigating the influence of a reduced GFR on the cardiovascular system as it eliminates the possible confounding effects of high blood pressure. The caveat, however, is that if blood pressure is a major distinguishing feature between donors and patients with chronic kidney disease, findings in kidney donors may not apply to those with CKD.…”

Section: Vascular Changesmentioning

confidence: 99%

“…Detailed studies of donors show small but significant structural and functional changes in the cardiovascular system at 1 year after nephrectomy. 4 , 5 In addition, a single but carefully designed study appears to show a late rise in adverse cardiovascular events. 6 Studies of living kidney donors appear to be a good approach to disentangling the complex association of renal and cardiovascular disease allowing important pathophysiological information on the mechanisms of the association of chronic kidney disease (CKD) and cardiovascular disease to be gained.…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Price

Edwards

Hayer

et al. 2018

Journal of the American Society of Hypertension

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Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. Although epidemiologic data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear.Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. After nephrectomy, the glomerular filtration rate ultimately falls by about one-third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. However, initial data suggested no increase in adverse cardiovascular effects compared with control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long-term significance of these small changes is unknown. More detailed and long-term research is needed to determine the natural history of these changes and their clinical significance.

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Abnormal P‐wave terminal force in lead V₁ is a marker for atrial electrical dysfunction but not structural remodelling

et al. 2021

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Aims There is a lack of diagnostic and therapeutic options for patients with atrial cardiomyopathy and paroxysmal atrial fibrillation. Interestingly, an abnormal P-wave terminal force in electrocardiogram lead V 1 (PTFV 1 ) has been associated with atrial cardiomyopathy, but this association is poorly understood. We investigated PTFV 1 as a marker for functional, electrical, and structural atrial remodelling. Methods and results Fifty-six patients with acute myocardial infarction and 13 kidney donors as control cohort prospectively underwent cardiac magnetic resonance imaging to evaluate the association between PTFV 1 and functional remodelling (atrial strain). To further investigate underlying pathomechanisms, right atrial appendage biopsies were collected from 32 patients undergoing elective coronary artery bypass grafting. PTFV 1 was assessed as the product of negative P-wave amplitude and duration in lead V 1 and defined as abnormal if ≥4000 ms*μV. Activity of cardiac Ca/calmodulin-dependent protein kinase II (CaMKII) was determined by a specific HDAC4 pull-down assay as a surrogate for electrical remodelling. Atrial fibrosis was quantified using Masson's trichrome staining as a measure for structural remodelling. Multivariate regression analyses were performed to account for potential confounders. A total of 16/56 (29%) of patients with acute myocardial infarction, 3/13 (23%) of kidney donors, and 15/32 (47%) of patients undergoing coronary artery bypass grafting showed an abnormal PTFV 1 . In patients with acute myocardial infarction, left atrial (LA) strain was significantly reduced in the subgroup with an abnormal

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Effects of Reduced Kidney Function Because of Living Kidney Donation on Left Ventricular Mass

Abstract: The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl

Cited by 15 publications

References 42 publications

Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Abnormal P‐wave terminal force in lead V₁ is a marker for atrial electrical dysfunction but not structural remodelling

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Effects of Reduced Kidney Function Because of Living Kidney Donation on Left Ventricular Mass

Abstract: The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl

Cited by 15 publications

References 42 publications

Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

Long‐term risk for kidney donors with hypertension at donation – a retrospective cohort study

Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Abnormal P‐wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling

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Abnormal P‐wave terminal force in lead V₁ is a marker for atrial electrical dysfunction but not structural remodelling