Key result
Kidney transplantation in ESRD is associated with an ~18g LV mass reduction and improved filling pressure.
Why the study?
Diastolic dysfunction is an early marker of cardiac pathology in end-stage kidney disease patients, and E/e'sr is a novel non-invasive marker of early left ventricular filling pressure.
Does kidney transplantation improve left ventricular remodeling and diastolic function in patients with end-stage renal disease?
Cohort (n=33)
Does kidney transplantation improve left ventricular remodeling and diastolic function in patients with end-stage renal disease?
Absolute Event Rate: 171.1% vs 189.2%
p-value: p=0.014
Kidney transplantation in patients with end-stage renal disease is associated with reverse left ventricular remodeling and improved LV filling pressure as assessed by novel echocardiographic markers at 6 months.
Kidney transplant was associated with reverse LV remodeling in ESRD; hypothesis-generating, prospective trials needed before practice change.
BACKGROUND: Diastolic dysfunction is an early marker of cardiac pathology in end-stage kidney disease (ESKD) patients. The ratio of transmitral filling velocity (E) to early diastolic strain rate (E/e'sr) is a novel non-invasive marker of early left ventricular (LV) filling pressure obtained using two-dimensional speckle tracking echocardiography (2DSTE). METHODS: In a prospective cohort of kidney transplant (KTX) recipients with echocardiograms performed pre-transplant we obtained repeat echocardiograms at 6 months following transplant. All echocardiograms were analyzed using 2DSTE where E/e'sr and global longitudinal strain were obtained. Paired tests were used to assess changes to cardiac structure and function following KTX. RESULTS: A total of 33 patients were included in the study (mean age was 46.6 ± 13.7 years and 42% were males). The primary causes of ESKD in the cohort were glomerular disease (33%), hypertension (30%), and polycystic kidney disease (12%). The median (IQR) time spent on dialysis was 5.4 years [2.9, 7.7 years]. A reverse remodeling of the LV was observed following KTX as LV mass decreased (189.2 ± 57.5 g vs 171.1 ± 56.8 g, P = 0.014). LV filling pressure decreased as assessed by E/e'sr (103.7 ± 51.1 cm vs 72.6 ± 35.5 cm, P = 0.009). E to early diastolic mitral annular tissue velocity (E/e') did not change following KTX (9.9 ± 4.5 vs 10.3 ± 4.1, P = 0.54). Additionally, both LV internal diastolic and systolic diameter decreased significantly. CONCLUSION: Reverse cardiac remodeling following KTX was observed as improvements in LV mass and LV dimensions. LV filling pressure improved as assessed by E/e'sr decreased following KTX, whereas E/e' did not change.
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Lassen et al. (2021) conducted a cohort in End-stage renal disease (n=33). Kidney transplantation vs. Pre-transplant baseline was evaluated on Left ventricular mass (p=0.014). Kidney transplantation in end-stage renal disease patients significantly reduced left ventricular mass (189.2 vs 171.1 g, P=0.014) and improved left ventricular filling pressure at 6 months.
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