Jasminka Dzemidzic, Rasic Senija, Rebic Damir, Uncanin Snezana
Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.
Mater Sociomed. 2015 Apr;27(2):104-7. doi: 10.5455/msm.2015.27.104-107. Epub 2015 Apr 5.
Hypertension (HT) and renal anaemia (RA) are well-established markers of cardiovascular risk in patients with chronic kidney disease (CKD). They appear to be the stimuli for left ventricular hypertrophy (LVH), who significantly participates in cardiac complications in uremic patients. Hypertension is extremely common after kidney transplantation (KTx) and it has been observed in up to 75% of patients. The prevalence of post-renal transplant anaemia (PTA) is variable (up to 30%) and several factors such as graft function contribute towards its pathophysiology.
The aim of this study was to analyze the impact of blood pressure and anaemia on LV remodelling in first year after transplantation comparing echocardiographic findings before and twelve months after transplantation had done.
In five years retrospective-prospective study we followed up 30 patients with renal allograft in first post-transplant year. During the study values of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), blood hemoglobin (Hgb), serum creatinine and creatinine clearance were monitored monthly.
Before transplantation (Tx) 86% of patients had HT, and RA was confirmed in all patients. Normal echocardiographic findings had 33% of patients and 67% of patients had echocardiographic sings of LVH. Before renal transplantation group with LVH had statistically higher the mean values of blood pressure (MBP) (p=0.053) compared to group with diastolic (LVDDF) (p=0.0047) and systolic-diastolic dysfunction (LVSDDF) (p=0.0046). The values of SBP and DBP positively correlated with LV mass index (LVMI) in the group of patients with LVH (p=0.0007 and p=0.0142). The values of Hgb was statistically higher in group with normal LV mass index compared to LVH (p=0.019), with negative correlation between LVMI and values of Hgb in the patients group with LV hypertrophy (p=0.009). After the first year of transplantation, 63% of patients showed normal LV mass index and 37% remained with echocardiographic findings of the LVH. The values of SBP and values of Hgb in both groups, as well as values of DBP in group of LVH were statistically different in compare with data before transplantation (p<0.05). The positive echocardiographic remodelling of LV significantly correlated with the increase of Hgb values (p=0.05), but without significant correlation with the decrease of the mean SBP and DBP.
These results confirmed that positive echocardiographic remodelling of left ventricle after successful renal transplantation is complex process depended on many risk factors and elimination of uremia- related factors is a priority.
高血压（HT）和肾性贫血（RA）是慢性肾脏病（CKD）患者心血管风险的公认标志物。它们似乎是左心室肥厚（LVH）的刺激因素，而左心室肥厚在尿毒症患者的心脏并发症中起重要作用。高血压在肾移植（KTx）后极为常见，在高达75%的患者中都有观察到。肾移植后贫血（PTA）的患病率各不相同（高达30%），移植肾功能等多种因素对其病理生理过程有影响。
本研究的目的是通过比较移植前和移植后12个月的超声心动图检查结果，分析移植后第一年血压和贫血对左心室重塑的影响。
在一项为期五年的回顾性-前瞻性研究中，我们对30例肾移植患者进行了移植后第一年的随访。在研究期间，每月监测收缩压（SBP）、舒张压（DBP）、平均血压（MBP）、血红蛋白（Hgb）、血清肌酐和肌酐清除率的值。
移植前（Tx），86%的患者患有高血压，所有患者均确诊为肾性贫血。33%的患者超声心动图检查结果正常，67%的患者有左心室肥厚的超声心动图表现。肾移植前，左心室肥厚组的平均血压（MBP）值在统计学上高于舒张功能不全组（LVDDF）（p = 0.053）和收缩-舒张功能不全组（LVSDDF）（p = 0.0047和p = 0.0046）。在左心室肥厚患者组中，收缩压和舒张压值与左心室质量指数（LVMI）呈正相关（p = 0.0007和p = 0.0142）。左心室质量指数正常组的血红蛋白值在统计学上高于左心室肥厚组（p = 0.019），在左心室肥厚患者组中，左心室质量指数与血红蛋白值呈负相关（p = 0.009）。移植一年后，63%的患者左心室质量指数正常，37%的患者仍有左心室肥厚的超声心动图表现。与移植前的数据相比，两组的收缩压值和血红蛋白值，以及左心室肥厚组的舒张压值在统计学上均有差异（p < 0.05）。左心室的正向超声心动图重塑与血红蛋白值的增加显著相关（p = 0.05），但与平均收缩压和舒张压的降低无显著相关性。
这些结果证实，成功肾移植后左心室的正向超声心动图重塑是一个复杂的过程，取决于许多危险因素，消除与尿毒症相关的因素是首要任务。
