Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Hewing, Bernd; Dehn, Anna Maria; Staeck, Oliver; Knebel, Fabian; Spethmann, Sebastian; Stangl, Karl; Baumann, Gert; Dreger, Henryk; Budde, Klemens; Halleck, Fabian

doi:10.1159/000450559

Cited by 53 publications

(70 citation statements)

References 36 publications

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“…LVH is the most commonly observed cardiac change in patients with ESRD patients, and it is a result of multiple factors including chronic uremia (which also induces cardiac fibrosis), hemodynamic changes (such as systemic hypertension and volume overload), and changes in the metabolic or hormonal status . Although in our study casual and ambulatory blood pressure measurements were similar before/after the transplantation except the mean Z scores of 24 hour and nighttime mean DBP, the prevalence of LVH and mean LVMI decreased significantly after the transplantation.…”

Section: Discussionmentioning

confidence: 43%

Hypertension and improved left ventricular mass index in children after renal transplantation

Ramoğlu

Uçar

Yılmaz

et al. 2017

Pediatric Transplantation

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This study was conducted to evaluate the changes in BP and LVH after the transplantation and to evaluate the effect of BP changes in LVH. Forty-three pediatric renal transplant patients, with a mean age of 16.99 ± 3.88 years, were enrolled in this study. Twenty-three (53.5%) of the patients were male. Medical records for pretransplantation period (closest to the time of transplantation) and for post-transplantation period (9-12 months after transplantation) were reviewed. All the patients had BP measurements and echocardiographic evaluation in pre- and post-transplantation period. Hypertension was defined as an average systolic and/or diastolic BP that is ≥95th percentile for sex, age, and height. Although the number of patients with hypertension increased from 30 (69.76%) to 35 (81.4%), the number of patients with LVH decreased from 19 (44.1%) to 9 (20.9%) after the transplantation. Although the only significant difference in BP measurements was between the mean Z scores of 24 hour and nighttime mean DBP before and after the transplantation; the mean LVMI, and the prevalence of LVH was significantly lower after the transplantation. There was no significant correlation between the LVMI and the BP measurements. Even though hypertension may persist, there is significant improvement in LVH after renal transplantation.

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Section: Discussionmentioning

confidence: 43%

Hypertension and improved left ventricular mass index in children after renal transplantation

Ramoğlu

Uçar

Yılmaz

et al. 2017

Pediatric Transplantation

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“…Although available studies on GLS after transplantation are scant, improvement in subclinical LV systolic function is reported after successful kidney transplantation [26, 27]. Better LV strain was shown in KTRs evaluated by backscatter echocardiography [26] and more recently in 31 KTRs who underwent speckle echocardiography to assess their LV systolic function before and after grafting; however, the lack of a control group does not allow ascertaining whether GLS renormalized after kidney transplantation [27]. …”

Section: Discussionmentioning

confidence: 99%

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

et al. 2018

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Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <–18% was shown in 55% of patients with stage 2–4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.

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“…Mortality after renal transplantation is still high, and cardiovascular complications are the leading cause of death in RTRs [7, 8]. RTRs usually have heightened activity of the sympathetic nervous system so therapy with BB may offer a survival benefit.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Kuźmiuk-Glembin

Adrych

Tylicki

et al. 2018

Kidney Blood Press Res

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Background/Aims: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital. Methods: Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens. Results: The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often. Conclusion: The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role.

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Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Cited by 53 publications

References 36 publications

Hypertension and improved left ventricular mass index in children after renal transplantation

Hypertension and improved left ventricular mass index in children after renal transplantation

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

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