1Department of Internal Medicine, Hospital Lapeyronie, CHU Montpellier, France. 2Department of Nephrology, Hospital Lapeyronie, CHU Montpellier, France. 3Address correspondence to: Docteur Guilhem du Cailar, MD, Departments of Internal Medicine and Nephrology, Hospital Lapeyronie, 34295 Montpellier Cedex 5 France.
Transplantation. 2014 Jul 27;98(2):202-7. doi: 10.1097/TP.0000000000000043.
We hypothesized that dietary sodium may modulate the effect of systolic blood pressure and other nonhemodynamic factors, such as high uric acid and renal dysfunction, on changes in the left ventricular mass after renal transplantation. The objective of the present 3-year follow-up longitudinal study was to assess the concomitant influence of these factors on changes in the left ventricular mass after renal transplantation.
Twenty-four-hour urinary sodium excretion, glomerular filtration rate (isotopic clearance), and left ventricular mass (echocardiography) assessment were done in 165 renal transplant patients during the first year and after a follow-up of 3 years after renal transplantation.
At follow-up, therapy of hypertension was associated with normalization of blood pressure in 64% and a decrease in the prevalence of left ventricular hypertrophy from 66% to 56%. At baseline and follow-up, systolic blood pressure, sodium intake, and serum uric acid emerged as independent and significant determinants of the final left ventricular mass index. When the population was divided according to sex-specific tertiles of the final 24-hr urinary sodium excretion, the relationship between change in serum uric acid during follow-up, final left ventricular mass index, and final glomerular filtration rate was significant only on the highest tertile of 24-hr urinary sodium excretion.
The decrease in the prevalence of left ventricular hypertrophy after renal transplantation is blunted by high sodium intake. Persistence of the left ventricular hypertrophy may result from the combined adverse influences of excessive dietary sodium intake and increased serum uric acid during follow-up despite pharmacological control of blood pressure.
我们假设饮食中的钠可能会调节收缩压和其他非血流动力学因素（如高尿酸血症和肾功能不全）对肾移植后左心室质量变化的影响。本 3 年随访纵向研究的目的是评估这些因素对肾移植后左心室质量变化的同时影响。
在肾移植后的第一年和 3 年随访期间，对 165 例肾移植患者进行了 24 小时尿钠排泄、肾小球滤过率（同位素清除率）和左心室质量（超声心动图）评估。
随访时，高血压治疗使 64%的患者血压正常，并使左心室肥厚的患病率从 66%降至 56%。在基线和随访时，收缩压、钠摄入量和血尿酸是左心室质量指数最终值的独立且重要的决定因素。当根据最终 24 小时尿钠排泄的性别特异性三分位数将人群分为亚组时，只有在最高三分位数的 24 小时尿钠排泄时，随访期间血清尿酸的变化、最终左心室质量指数和最终肾小球滤过率之间的关系才具有统计学意义。
肾移植后左心室肥厚患病率的下降被高钠摄入所掩盖。尽管通过药物控制血压，但由于饮食中钠摄入过多和尿酸升高，左心室肥厚的持续存在可能会导致联合不良影响。
