Abstract

Background: Cardiovascular disease and kidney disease seem to be lethally synergistic and both approach the level of epidemic. Patients with cardiovascular disease have often impaired kidney function, while on the other hand cardiovascular disease is the single best predictor of mortality in patients with chronic kidney disease. The risk in a patient with moderate impaired renal function is comparable in magnitude with that of a patient with diabetes mellitus. The aim of the study was to assess the risk factors for kidney dysfunction in a 162 consecutive heart transplant recipients (129 males, 22 females). Stages of chronic kidney disease were defi ned according to K/DOQI guidelines using estimated GFR.
Results: Mean serum creatinine in this population was 1.70±1.08 mg/dl (ranges from 0.54-9.34 mg/dl); mean age was 54±14 years; mean time after transplantation was 106±52 months (ranges 10-210 months). Mean GFR was 62.92±31.04 ml/min (Cockcroft-Gault formula), 55.38±26.74 ml/min (MDRD) and 62.62±35.61 ml/min (creatinine clearance). Estimated GFR, creatinine clearance, serum creatinine correlated in univariate analysis with haemoglobin, RBC count, age, time after transplantation, ejection fraction, NT-proBNP, use of calcineurine inhibitors. In multiple regression analysis predictors of kidney function (GFR) were age (beta value -0.47, p<0.001), time after transplantation (beta value -0.22, p=0.03) and haemoglobin (beta value 0.31, p-0.03) explaining the 51% of variation of GFR in this group. When GFR was substituted by creatinine clearance the results were the same. Conclusions: In heart transplant recipients kidney function is predominantly dependent upon age, time after transplantation (both non-modifi able causes) and anaemia (which could be modified).

Keywords: Heart Transplantation, Immunosuppression