The impact of renal transplantation on the incidence of congestive heart failure in patients with end-stage renal disease due to diabetes

Background: Patients with end stage renal disease (ESRD) are at increased r isk for cardiovascular disease. We hypothesized that the clinical incidence of congestive heart failure (CHF) would be lessened after successful renal transplantation, as many of the metabolic and intravascular volume abnorma lities associated with dialysis-dependent ESRD would resolve. Methods: Using data from the USRDS, we studied 11,369 patients with ESRD du e to diabetes enrolled on the renal and renal-pancreas transplant waiting l ist from I July 1994-30 June 1997. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) f or time to the most recent hospitalization for CHF (including acute myocard ial infarction, unstable angina, or other CHF, ICD9 Code 428.x) for a given patient in the study period, controlling for both demographics and comorbi dities in the medical evidence form (HCFA 2728). Results: In comparison to maintenance dialysis, renal transplantation was i ndependently associated with a lower risk for CHF (HR 0.64, 95% confidence interval, 0.54-0.77) in a model including age, gender, race, and year of fi rst dialysis, but not in a model including comorbidities from the medical e vidence form, although the sample was much smaller. Conclusions: Patients with ESRD due to diabetes on the renal transplant wai ting list were much less likely to be hospitalized for congestive heart fai lure after renal transplantation, despite post transplant complications due to immunosuppression.