Longitudinal assessment of cardiac morphology and function following kidney transplantation

Abstract

Background Abnormal cardiac morphology is a risk factor for cardiovascular complications in kidney transplant patients. A supraphysiologic level of fibroblast growth factor 23 (FGF-23) has been associated with myocardial hypertrophy in this patient population. Our aim was to evaluate the change in cardiac morphology and function following kidney transplantation and to evaluate the association between the change in FGF-23 concentrations and cardiac morphology. Methods We performed a longitudinal, prospective cohort study of 143 kidney transplant recipients (73% male, 75% white) measuring left ventricular (LV) mass index, left atrial (LA) volume index, and ejection fraction (EF) by echocardiography at months 1, 12, and 24 post-transplant. FGF-23 levels were measured at months 1 and 24 post-transplant. Results Unadjusted and adjusted linear mixed effects models were used to examine changes in outcomes over time. In the adjusted model, LV mass index (P<0.001) and LA volume index (P<0.001) decreased and EF (P=0.009) increased significantly over time. There was a significant association between decreasing FGF-23 levels and improving LV mass index following transplant (P=0.036) in the unadjusted model; however, there was no significant relationship in the adjusted model (0.195). Conclusion Understanding the progression of unique cardiovascular risk factors associated with kidney transplantation may provide potential opportunities to improve survival.

Associations between normal range albuminuria, renal function and cardiovascular function in a population-based imaging study

“…Previous cardiovascular magnetic resonance-based studies, evaluating the relationship between normo-to microalbuminuria and LV mass in non-CKD populations, were performed solely in hypertensive individuals [9,10], limiting conclusions on whether found associations were independent of blood pressure. Our findings are supported by the improved cardiac function and decrease in LV mass index after renal transplantation [22,23]. Moreover, elevated circulating levels of endothelial glycocalyx degrading enzyms, such as syndecan-1 and thrombomodulin, have shown to normalize after kidney transplantation, indicating an improved systemic endothelial function [24].…”

The Risk of Stroke in Kidney Transplant Recipients with End-Stage Kidney Disease

“…This finding resonated with other studies that discerned evidence of a reduced risk for stroke after KT [23]. With respect to the pathogenesis of vascular function after KT, studies from Kensinger et al reported a significant association between decreased fibroblast growth factor 23 levels and improved left ventricular mass index following transplantation, and that the improved endothelial function after transplantation was maintained for up to two years [29,30]. KT also ameliorated dyslipidemia, which is a well-recognized cardiovascular disease risk factor characterized by a decreased concentration of high-density lipoprotein and an increased concentration of triglycerides that is associated with kidney impairment [31].…”

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

“…The cohort of KTRs suffers from many cardiovascular complications. Echocardiographic abnormalities, as well as concentric hypertrophy and concentric remodeling [23], are common findings, resulting in left ventricular dysfunction [24]. Although no major differences in the prevalence of self-reported complaints have been found between the analyzed patient groups in our study, the use of LVD-36 questionnaire allowed to uncover more discrete discrepancies regarding EC in this patient cohort.…”