Year: 2018
Type: conference-abstract
Abstract: INTRODUCTION AND AIMS: Cardiovascular (CV) assessment is one of the most important steps in kidney transplantation (KT) evaluation, as it encompasses short and long term morbidity and mortality risk. Optimal strategy for CV assessment is an issue under debate and it is far from beeing totally defined. We aimed to overhaul risk strategy evaluation and outcomes in patients studied at our hospital. METHODS: Demographic, clinical and biochemical data were recorded. CV events included acute coronary syndromes (ACS), heart failure (HF), valve disease and arrhythmias, as well as procedures during follow-up. Cinecoronariography (CCG) was indicated if P were ≥ 50 years old (y) without diabetes (DBT) or ≥ 40 y and DBT or history of angina, time on dialysis ≥5 years, HF admissions, myocardial infarction, systolic dysfunction, ventricular arrhythmia or positive functional assessment. Isolated KT and combined kidney-liver or kidney-pancreas transplants were considered for analysis, while combined TX with other solid organs not. Mineral and bone disorders (MBD) were defined following KDIGO guidelines. RESULTS: A total of 923 P were assessed between January, 2011 and September, 2017. Fifty nine percent were males, aged 50±15 y; 53% older than 50 y. History of hypertension in 79%, dyslipidemia in 71%,DBT in 19% were found, while 48% had MBD; 13% previously transplanted. KT was performed in 50.3% of assessed P, in 3.1% on a preemptive basis. Any cardiac disease was found in 47% of assessed P, being ischaemic heart disease (IHD) the most common (21% of the population). CCG was performed in 43.5%, with almost normal angiograms in 36%. While a total of 25.3% had pre-KT CV events, 44.5% had any after KT. Pre-KT CV events were associated with age > 60 y (OR 1.72; p= 0.03), dialysis longer than 5 y (OR 2.67; p= 0.04), previous ischaemic heart disease (OR 4.9; p< 0.001), previous HF (OR 3.75; p< 0.001) and hyperphosphatemia (OR 4.23; p< 0.001). There was no association between documented myocardial ischaemia and events neither in pre-KT (25 vs 26.7%; p= 0.89) nor in post-KT periods (35 vs 37.5%; p= 0.90), as high pre-KT revascularization rates were achieved (13.5%). Multiple logistic regression analysis revealed previous ischaemic heart disease (OR 2.81; p= 0.03) and long dialysis periods (2.95; p= 0.04) as independent predictors for pre-KT CV events. Inadequate phosphate control (OR 3.34; p= 0.07) and pre-KT ischaemic heart disease (OR 3.59; p= 0.06) were associated with post transplant mortality. CONCLUSIONS: Cardiac disease is a frequent and severe comorbid state in CKD who are assessed for kidney transplantation. Ischaemic heart disease and mineral and bone disorders are related with bad outcomes in this setting. Aggressive diagnostic and therapeutic approach may warrant lower event rates and enhances outcomes in Kidney transplant environment.
Institution: Favaloro Foundation
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2803604079