CARDIAC CHARACTERISTICS OF PATIENTS WITH END-STAGE RENAL-DISEASE AFTER KIDNEY-TRANSPLANTATION

Left ventricular (LV) hypertrophy and dysfunction are risk factors for high mortality from cardiovascular causes in patients with end-stage renal disease. To determine the frequency of these findings after kidn ey transplantation, 45 patients (11 female, 34 male; age: 47.2 +/- 12 years) after transplantation (57 +/- 37 months) with (n = 21) and with out (n = 24) a patent arteriovenous fistula were analyzed with echocar diography. A high prevalence of systolic (> 140 mm Hg: 40 %) and diast olic (> 90 mm Hg: 18 %) hypertension was observed despite the use of 1 .44 +/- 0.9 (range: 0-3) antihypertensive drugs per patient. Most freq uent echocardiographic findings were LV hypertrophy (78 %; LV mass = 3 18 +/- 81 g), mostly in the asymmetric septal form (47%; mean ratio se ptal/posterior wall thicknesses: 1.38 +/- 0.2), and left atrial dilata tion (60 %; mean diameter: 44 +/- 6 mm). LV dilatation (33 %; mean end diastolic diameter: 53 +/- 5 mm) and systolic dysfunction (20 %; mean ejection fraction: 64 +/- 11 %) were less common. Individual values of LV mass were directly correlated with systolic blood pressure (p < 0. 05). No relation was found between other echocardiographic (LV and lef t atrial diameters, LV mass, ejection fraction or velocity of circumfe rential fibre shortening) and clinical (transplantation duration, seru m hemoglobin or creatinine, patency of dialysis access, or choice of i mmunosuppressive therapy) parameters. The presented data suggest that LV hypertrophy is frequent after renal transplantation, and that arter ial hypertension is a key factor for the maintenance of LV hypertrophy in these patients, while the patency of the dialysis access, and the durations of transplantation or of preceding dialysis therapy are not relevant. Therefore, adequate blood pressure control, but not rapid cl osure of the arteriovenous fistula, may be the measure of choice to pr event LV hypertrophy in end-stage renal disease patients after renal t ransplantation.