Left ventricular myocardial hypertrophy after transplantation of the kidney: risk factors and possible regress


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Aim. To study structural-functional changes in left ventricular (LV) myocardium in recipients of renal allograft (RA) after different postoperative period and to specify factors promoting persistence, progression or regression of LV hypertrophy (LVH).
Material and methods. The study included 240 recipients of primary RA (38% females and 62% males, age 16-69 years, mean age 42 ± 11 years). A prospective study covered 143 patients.
Results. LVH was diagnosed in 52% patients. LVH incidence after renal transplantation (RT) had a wave-like dynamics: during 9 months after RT LVH presents in more than 50% patients; after 9-24 months after the operation it fell to 30% and after 3-7 years after the operation it affected at least 2/3 patients. After RT LVH risk factors were age, duration of chronic renal failure (CRF) and pretransplantation dialysis, reduced mass of the operating nephrons, arterial hypertension, anemia, functioning of arterio-venous fistula (AVF) and chronic inflammation syndrome. LVH was also associated with factors specific for RT: RA rejection crises, infections complicating massive immunosuppressive therapy. LVH is also associated with proteinuria which may indicate RA damage and can be considered as a marker of generalized endothelial dysfunction. 2-year and longer follow-up after RT confirmed complete LVH regression in 1/3 of the recipients. LVH regression was observed in normal RA function, normal blood pressure, the absence of proteinuria, hypoalbuminemia, anemia, AVF, infectious complications.
Conclusion. LVH after RT is multifactorial and can completely regress in a favourable posttransplantation course.

References

  1. Grassmann A., Gioberge S., Moeller S. et al. ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol. Dial. Transplant. 2005; 20: 2587-2593.
  2. U. S. Renal Data System, USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Am. J. Kidney Dis. 2006; 47 (suppl. 1).
  3. Бикбов Б. Т., Томилина Н. А. Состояние заместительной терапии больных с хронической почечной недостаточностью в Российской Федерации в 1998-2005 гг. Нефрол. и диализ 2007; 9 (1): 6-86.
  4. Данович Г. М. Руководство по трансплантации почки: Пер. с англ. под ред. Я. Г. Мойсюка. 3-е изд. Тверь; 2004: 255-294.
  5. Шумаков В. И., Томилина Н. А., Ким И. Г. и др. Ишемическая болезнь сердца после трансплантации почки: эпидемиология, факторы риска и хирургические подходы к лечению. Вестн. РАМН 2006; 11: 31-37.
  6. Kasiske B. L. Epidemiology of cardiovascular disease after renal transplantation. Transplantation 2001; 72: 5-8.
  7. Rigatto C. Clinical epidemiology of cardiac disease in renal transplant recipients. Semin. Dial. 2003; 16: 106-110.
  8. Шляхто Е. В., Конради А. О., Захаров Д. В. и др. Структурно-функциональные изменения миокарда у больных гипертонической болезнью. Кардиология 1999; 2: 49-55.
  9. Foley R. N., Parfrey P. S., Harnett J. D. et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int. 1995; 47: 186-192.
  10. Foley R. N., Parfrey P. S., Harnett J. D. et al. Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J. Am. Soc. Nephrol. 2000; 11: 912-916.
  11. Levin A., Singler J., Thompson C. R. et al. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am. J. Kidney Dis. 1996; 27: 347-354.
  12. Бадаева С. В., Томилина Н. А., Бикбов Б. Т. и др. Структурно-функциональные изменения миокарда при прогрессирующей хронической почечной недостаточности. Нефрол. и диализ 2006; 8 (3): 15-24.
  13. Rigatto C., Parfrey P. Factors governing cardiovascular risk in the patient with a failing renal transplant. Perit. Dial. Int. 2001; 21: 275-279.
  14. Саенко Ю. В., Шутов А. М. Роль оксидативного стресса в патологии сердечно-сосудистой системы у больных с заболеваниями почек. (Сообщение II. Клинические аспекты оксидативного стресса). Нефрол. и диализ 2004; 6 (2): 138-144.
  15. Hernandez D. Left ventricular hypertrophy after renal transplantation: new approach to a deadly disorder. Nephrol. Dial. Transplant. 2004; 19: 1682-1686.
  16. Himelman R. B., Landzberg J. S., Simonson J. S. et al. Cardiac consequences of renal transplantation: changes in left ventricular morphology and function. J. Am. Coll. Cardiol. 1988; 12: 915-923.
  17. Parfrey P. S., Harnett J. D., Foley R. N. et al. Impact of renal transplantation on uremic cardiomyopathy. Transplantation 1995; 60: 908-914.
  18. Ferreira R. C., Moises V. A., Taraves A. et al. Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 2002; 74 (11): 1580-1587.
  19. Rigatto C., Foley R., Jeffery J. et al. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia. J. Am. Soc. Nephrol. 2003; 14: 462-468.
  20. Huting J. Course of left ventricular hypertrophy and function in end-stage renal disease after renal transplantation. Am. J. Cardiol. 1992; 70: 1481-1484.
  21. DeCastro S., Migliau G., Giannantoni P. et al. Persistence of abnormal left ventricular filling following renal transplantation. Transplant. Proc. 1993; 25: 2603-2604.
  22. Stoves J., Lindley E. J., Barnfield M. C. et al. MDRD equation estimates of glomerular filtration rate in potential living kidney donors and renal transplant recipients with impaired graft function. Nephrol. Dial. Transplant. 2002; 17: 2036-2037.
  23. Devereux R. B., Alonso D. R., Lutas E. M. et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am. J. Cardiol. 1986; 57: 450-458.
  24. Шиллер Н., Осипов М. А. Клиническая эхокардиография. 2-е изд. М.: Практика; 2005. 62-103.
  25. Гланц С. Медико-биологическая статистика. М.: Практика; 1999.
  26. De Lima J. J., Vieira L. C., Viviani L. F. et al. Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients. Nephrol. Dial. Transplant. 2002; 17: 645-651.
  27. El-Husseini A. A., Sheashaa H. A., Hassan N. A. et al. Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation. Pediatr. Transplant. 2004; 8 (3): 249-254.
  28. Meier-Kriesche H.-U., Schold J. D., Srinivas T. R. et al. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am. J. Transplant. 2004; 4: 1662-1667.
  29. Fishman J. A., Rubin R. H. Infection in organ-transplant recipients. N. Engl. J. Med. 1998; 338: 1741-1751.
  30. Pontremoli R., Sofia A., Ravera M. et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC study. Microalbuminuria: a Genoa Investigation on Complications. Hypertension 1997; 30: 1135-1143.
  31. Мухин Н. А., Фомин В. В., Моисеев С. В., Нанчикеева М. Л. Микроальбуминурия - универсальный маркер неблагоприятного прогноза. Сердеч. недостат. 2008; 9: 79-82.
  32. Wachtell K., Olsen M. H., Dahlof B. et al. Microalbuminuria in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. J. Hypertens. 2002; 20: 405-412.

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