Lukkanalikitkul Eakalak, Pussadhamma Burabha, Ahooja Anucha, Ungprasert Phuangpaka, Toparkngam Panorkwan, Nawapun Supajit, Takong Wittawat, Toimamueang Ubonrat, Anutrakulchai Sirirat
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Int J Cardiol Heart Vasc. 2022 May 9;40:101048. doi: 10.1016/j.ijcha.2022.101048. eCollection 2022 Jun.
Patency of vascular accesses (VA) is associated with left ventricular hypertrophy (LVH) in kidney transplant recipients (KTR). This level of VA flow (VAF) as related to LVH was assessed and an upward level of VA flow recommended for VA closure determined. This recommendation has not been previously reported.
123 KTR cohort patients were enrolled between August 2016 and December 2017 and their LVH and LV mass index (LVMI) by echocardiography and VAF by Doppler ultrasound were evaluated at baseline and for a 24-month follow-up period. Associations between VAF and LVH were adjusted for other factors.
Patients with patent VA (55.3%) had significantly greater LVH (47.1 vs. 29.1%, an adjusted odds ratio 2.44, p = 0.03) and LVMI (112.15 ± 34.4 vs. 97.55 ± 23.55 g/m, p = 0.009) when compared with the non-VA group. A positive correlation between VAF rate and LVM was noted (r = 0.40, p < 0.001). Subgroup analysis revealed the VAF ≥ 900 ml/min had risks of LVH 3.61, and 2.86 times compared with the non-VA group and the VAF < 900 ml/min group. After a 24-month follow up, there was no significantly individual change in LVMI in patients with or without VA except 6 patients who lost their VA patency during follow-up time had a significant reduction of LVMI (120.17 ± 52.13 to 80.89 ± 22.72 g/m, p = 0.046).
Patency of VA in post-KT patients was associated with LVH. There was a significant reduction of LMVI after loss of VA patency. Patients with stable kidney graft function should be considered for VA closure especially if VAF is ≥ 900 ml/min.
肾移植受者（KTR）的血管通路（VA）通畅与左心室肥厚（LVH）相关。评估了与LVH相关的VA血流量（VAF）水平，并确定了VA闭合推荐的VA血流量上限。此前尚未有该推荐的报道。
2016年8月至2017年12月纳入123例KTR队列患者，在基线及24个月随访期通过超声心动图评估其LVH和左心室质量指数（LVMI），通过多普勒超声评估VAF。对VAF与LVH之间的关联进行其他因素校正。
与非VA组相比，VA通畅的患者（55.3%）LVH显著更严重（47.1%对29.1%，校正比值比2.44，p = 0.03），LVMI更高（112.15±34.4对97.55±23.55 g/m，p = 0.009）。观察到VAF率与左心室质量（LVM）呈正相关（r = 0.40，p < 0.001）。亚组分析显示，与非VA组和VAF < 900 ml/min组相比，VAF≥900 ml/min的患者发生LVH的风险分别为3.61倍和2.86倍。24个月随访后，有或无VA的患者LVMI均无显著个体变化，但6例在随访期间失去VA通畅的患者LVMI显著降低（从120.17±52.13降至80.89±22.72 g/m，p = 0.046）。
肾移植术后患者的VA通畅与LVH相关。VA通畅丧失后LVMI显著降低。对于肾移植功能稳定的患者，尤其是VAF≥900 ml/min时，应考虑闭合VA。
