Prolonged haemodialysis increases the risk of the impairment of global longitudinal strain in patient after kidney transplantation and a preserved ejection fraction of left ventricle

Abstract

Background. Patients with chronic kidney disease, including these after kidney transplantation (KTx), have higher cardiovascular mortality. Global longitudinal strain (GLS) detects subtle changes in the left ventricle (LV) and is more sensitive predictor of cardiovascular mortality than the LV ejection fraction (LVEF).The aim of this study was to assess the prevalence of impaired GLS among kidney transplant recipients with preserved LVEF. We also aimed to identify possible clinical factors responsible for GLS impairment. Methods. A total of 79 patients following KTx with preserved LVEF and no history of cardiac disease were evaluated. We assessed echocardiogram parameters with the calculation of GLS, laboratory parameters, presence of diabetes, hypertension, duration of haemodialysis (HD) and time after KTx. An impaired GLS value was set on ≥-18%. The multivariate stepwise logistic regression analysis were used to identify the factors related to impaired GLS. Results. Among 79 (42 females, mean age 60.3) kidney transplant recipients with preserved LVEF, 39% had impaired GLS. ROC analysis revealed that the cut-off point for the prediction GLS ≥-18 % by HD duration is more than 28 months (AUC 0.67 (95%CI 0.545-0.79; P=0.007). In multivariate stepwise logistic regression analysis for variables related to impaired GLS duration of HD more than 28month is associated with GLS ≥-18( OR 4.06; 95CI (1.45-11.34) P=0.008). Conclusions. In our study group, a total of 39% of KTx patients with preserved LVEF had impaired GLS. The risk factor of GLS impairment was a prolonged duration of HD (>28months) prior to the transplantation procedure.