Casas-Aparicio G, Castillo-Martínez L, Orea-Tejeda A, Abasta-Jiménez M, Keirns-Davies C, Rebollar-González V
Department of Nephrology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
Transplant Proc. 2010 Nov;42(9):3524-8. doi: 10.1016/j.transproceed.2010.06.026.
Heart disease is a frequent complication of chronic kidney disease and the major cause of death in patients on renal replacement therapy. The purpose of this study was to evaluate the impact of successful kidney transplantation on systolic and diastolic ventricular dysfunction and pulmonary arterial hypertension in patients with chronic kidney disease (CKD).
The study included 35 patients >18 years of age with CKD who had successful kidney transplantations. Ventricular function and pulmonary arterial pressure were evaluated by echocardiography before and 1 year after transplant.
The mean age of subjects was 40 ± 14 years, and 63% were men. Mean left ventricular ejection fraction (LVEF) was 52 ± 16%. Before transplant, 28 (80%) of the patients had ventricular dysfunction (34.3% diastolic and 45.7% systolic). Pulmonary arterial hypertension was found in 48.6%. Ventricular dysfunction was associated with dialysis of >2 years duration before transplant. The LVEF of the entire group increased from 52% to 64% (P < .001) by 12 months after kidney transplant. Left ventricular diameters, wall thickness, and pulmonary arterial systolic pressure decreased significantly after transplantation Echocardiograms became normal 1 year after transplant in 8 (66.7%) of the patients with diastolic dysfunction and 9 (56.2%) with systolic dysfunction, and diastolic dysfunction persisted in 5 (31.2%).
Because kidney transplantation led to considerable improvement in left ventricular systolic and diastolic function as well as pulmonary arterial pressure of patients with CKD, optimal treatment for dysfunction and transplant as soon as possible is recommended.
心脏病是慢性肾脏病的常见并发症，也是接受肾脏替代治疗患者的主要死因。本研究旨在评估成功的肾移植对慢性肾脏病（CKD）患者收缩和舒张期心室功能障碍及肺动脉高压的影响。
本研究纳入了35例年龄大于18岁且肾移植成功的CKD患者。在移植前及移植后1年通过超声心动图评估心室功能和肺动脉压力。
受试者的平均年龄为40±14岁，63%为男性。平均左心室射血分数（LVEF）为52±16%。移植前，28例（80%）患者存在心室功能障碍（舒张期功能障碍占34.3%，收缩期功能障碍占45.7%）。发现48.6%的患者存在肺动脉高压。心室功能障碍与移植前透析时间超过2年有关。肾移植后12个月时，整个组的LVEF从52%增加到64%（P<.001）。移植后左心室直径、室壁厚度和肺动脉收缩压显著降低。在存在舒张期功能障碍的患者中，8例（66.7%）在移植后1年超声心动图恢复正常；在存在收缩期功能障碍的患者中，9例（56.2%）恢复正常，5例（31.2%）舒张期功能障碍持续存在。
由于肾移植可使CKD患者的左心室收缩和舒张功能以及肺动脉压力得到显著改善，因此建议对功能障碍进行最佳治疗并尽早进行移植。
