Clinical and demographic factors associated with cardiac remodelling in renal transplant recipients

Renal transplantation significantly increases survival compared to dialysishowever, cardiovascular disease remains an important cause of mortality and morbidity in this population. Even after the restoration of kidney function and the subsequent regression of uremic cardiomyopathy, transplant recipients still present with adverse cardiac remodeling, specifically left ventricular hypertrophy and left atrial enlargement. The clinical and demographic determinants of these changes remain poorly described. The aim of our study was to map these predictors in order to refine risk stratification strategies. We conducted a cross-sectional analysis of 110 renal transplant patients. Key parameters included demographic data (age, sex, body mass index) and renal indicators (eGFR, dialysis vintage, age at transplant and transplant vintage). Echocardiographic examination was performed and interpreted according to international guidelines. The statistical analysis was conducted in two phases. Firstly, potential predictors were screened using univariable linear regression. Significant variables were then entered into a multivariable regression model to adjust for confounders. Secondly, patients were stratified into four groups based on left ventricular mass index (LVMi) and left atrial volume index (LAVi). We assessed the differences between the groups using ANOVA. Three participants were excluded due to incomplete data or severe valvular pathology. The final cohort consisted of 107 patients (66.7% males) with a mean age of 47 years and a mean eGFR of 64 mL/min/1.73 m2. The multivariable regression model for LVMi demonstrated that only age (p=0.038) and the number of antihypertensive agents (p=0.041) were independent predictors. Current renal function did not reach statistical significance (p=0.780). Left atrial enlargement predictors were dialysis vintage (p=0.029) and eGFR (p=0.011). Regression analysis showed that LAVi remains elevated at all eGFR values under 92 mL/min/1.73 m2, suggesting incomplete reverse remodeling after transplantation. Structural stratification demonstrated that patients with higher LVMi and LAVi were older (50.9 years vs. 41.8 years, p=0.022) and were transplanted at an older age (44.6 vs. 33.1 years, p=0.002). Furthermore, this group was associated with lower eGFR (55.3 vs. 74.6 mL/min/1.73 m2, p=0.012) and presented with more comorbidities (Charlson Comorbidity Index 1.2 vs. 0.4, p=0.024). Our study demonstrates that post-transplant cardiac remodeling follows two pathophysiological pathways. Atrial enlargement is largely dependent on the cumulative renal burden such as dialysis exposure and current renal function, whereas left ventricular hypertrophy is mainly the result of age and hypertension. The combined remodeling phenotype identifies a subgroup of patients who are older with worse graft function and more comorbidities requiring a more intensive cardioprotective approach.