Hernández Domingo, González Ana, Rufino Margarita, Laynez Ignacio, de la Rosa Alejandro, Porrini Esteban, Lacalzada Juan, Barragán Antonio, Lorenzo Víctor, Torres Armando
Department of Nephrology, Hospital Universitario de Canarias, E-38320, La Laguna, Tenerife, Spain.
Nephrol Dial Transplant. 2007 Sep;22(9):2678-85. doi: 10.1093/ndt/gfm247. Epub 2007 May 17.
Left ventricular hypertrophy (LVH) is common in chronic kidney disease (CKD), including kidney transplant recipients. However, time-related left ventricular mass changes (DeltaLVM) from pre-dialysis stage to beyond the first post-transplant year have not been clearly identified.
We studied a cohort of 60 stages 4-5 CKD patients without overt cardiac disease, who underwent three echocardiograms during follow-up: at pre-dialysis stage, on dialysis and after kidney transplantation (KT). Multiple linear regression was used to model DeltaLVM from baseline study. Cox proportional analysis was used to determine risk factors associated with either de novo LVH or>20% DeltaLVMI over time.
Patients with baseline LVH (n=37; 61%) had a higher body mass index (BMI) than those without LVH (n=23; 39%) (P=0.013). BMI, haemoglobin levels (P=0.047) and non-use of angiotensin-converting enzyme inhibitors (ACEI) (P=0.057) were associated with baseline left ventricular mass index (LVMI). Twelve out of 23 patients (52%) with normal LVM at baseline, developed either de novo LVH or>20% DeltaLVMI at follow-up. On the other hand, 29 (78%) of those with initial LVH maintained this abnormality, and 8 (22%) normalized LVM post-transplantation. Factors associated with DeltaLVMI were age (P=0.01), pre-dialysis LVMI (P<0.0001), serum creatinine (P=0.012) and the use of ACEI post-transplantation (P=0.009). In Cox analysis, pre-dialysis LVMI was associated with de novo LVH or>20% DeltaLVMI over time (hazard ratio 1.009; 95% confidence interval 1.004 to 1.015; P=0.001).
Successful KT may not completely normalize LVM post-transplantation. Pre-dialysis LVMI, traditional risk factors and no use of ACEI may perpetuate cardiac growth following KT.
左心室肥厚（LVH）在慢性肾脏病（CKD）中很常见，包括肾移植受者。然而，从透析前阶段到移植后第一年以后与时间相关的左心室质量变化（DeltaLVM）尚未明确。
我们研究了一组60例无明显心脏病的4-5期CKD患者，他们在随访期间接受了三次超声心动图检查：透析前阶段、透析时和肾移植（KT）后。采用多元线性回归对基线研究中的DeltaLVM进行建模。采用Cox比例分析来确定与新发LVH或随时间DeltaLVMI>20%相关的危险因素。
基线时存在LVH的患者（n=37；61%）的体重指数（BMI）高于无LVH的患者（n=23；39%）（P=0.013）。BMI、血红蛋白水平（P=0.047）和未使用血管紧张素转换酶抑制剂（ACEI）（P=0.057）与基线左心室质量指数（LVMI）相关。23例基线时LVM正常的患者中有12例（52%）在随访时出现新发LVH或DeltaLVMI>20%。另一方面，29例（78%）初始有LVH的患者维持了这种异常，8例（22%）在移植后LVM恢复正常。与DeltaLVMI相关的因素有年龄（P=0.01）、透析前LVMI（P<0.0001）、血清肌酐（P=0.012）和移植后使用ACEI（P=0.009）。在Cox分析中，透析前LVMI与随时间新发LVH或DeltaLVMI>20%相关（风险比1.009；95%置信区间1.004至1.015；P=0.001）。
成功的KT可能不会使移植后LVM完全恢复正常。透析前LVMI、传统危险因素以及未使用ACEI可能使KT后心脏持续生长。
