Renal and Transplantation Unit, St George's Hospital, University of London, London, UK.
J Nephrol. 2012 Nov-Dec;25(6):1119-25. doi: 10.5301/jn.5000103.
Echocardiographic abnormalities are well described in chronic kidney disease (CKD), and associated with increased cardiovascular events (CVEs) and mortality. Little is known regarding progression of these abnormalities in patients awaiting kidney transplantation.
We assessed the progression of echocardiographic variables in patients awaiting kidney transplantation and determined predictors of CVEs and mortality. The study included all patients awaiting kidney transplantation between 2004 and 2010 with repeat echocardiograms at least 1 year apart and at least 1 year after transplantation.
We assessed 79 patients (57% male, mean age 55 ± 11 years; 27% with diabetes). Sixty-three patients remained on waiting list, and 16 had kidney transplants. Two deaths and 2 CVEs occurred in patients awaiting kidney transplantation. Repeat echocardiograms (31 ± 19 months from baseline) on patients who remained on waiting list showed significant increases in left ventricular mass index (LVMI) (55.3 ± 17.8 vs. 60.5 ± 21.9 g/m2.7, p=0.02) and in left atrium (LA) diameter (3.8 ± 0.6 vs. 4.1 ± 0.8 cm, p=0.02). There were no significant changes in LV fractional shortening (FS) or LV end-systolic and end-diastolic dimensions. Left atrium diameter (p=0.005), systolic dysfunction (p=0.007) and LVMI (p=0.01) were independent predictors of CVEs and mortality.
Time on kidney transplant waiting list is associated with progressive increases in LA diameter and LVM, which are markers of adverse outcome.
慢性肾脏病（CKD）患者的超声心动图异常已得到充分描述，且这些异常与心血管事件（CVE）和死亡率的增加相关。然而，对于等待肾移植的患者，这些异常的进展情况知之甚少。
我们评估了等待肾移植患者的超声心动图变量的进展情况，并确定了 CVE 和死亡的预测因素。本研究纳入了 2004 年至 2010 年间所有至少接受过两次超声心动图检查且两次检查时间至少间隔 1 年、且至少在移植后 1 年的等待肾移植患者。
我们评估了 79 例患者（57%为男性，平均年龄 55±11 岁；27%患有糖尿病）。63 例患者仍在等待名单上，16 例患者接受了肾移植。等待肾移植的患者中有 2 例死亡和 2 例 CVE。仍在等待名单上的患者的重复超声心动图（距基线 31±19 个月）显示左心室质量指数（LVMI）（55.3±17.8 比 60.5±21.9 g/m2.7，p=0.02）和左心房（LA）直径（3.8±0.6 比 4.1±0.8 cm，p=0.02）显著增加。LV 节段缩短（FS）和 LV 收缩末期和舒张末期直径无显著变化。LA 直径（p=0.005）、收缩功能障碍（p=0.007）和 LVMI（p=0.01）是 CVE 和死亡的独立预测因素。
在肾移植等待名单上的时间与 LA 直径和 LVM 的进行性增加相关，而 LA 直径和 LVM 是不良结局的标志物。
