Abstract

Background: Patients with cardiovascular diseases often show signs of renal dysfunction due to concomitant diabetes, hypertension, and congestive heart failure. Studies have shown that GFR (glomerular filtration rate) less than 60 ml/min is a forerunner of premature cardiovascular death. The aim of the study was to assess the prevalence of kidney dysfunction in heart transplant recipients using estimated GFR according to simplified MDRD, Cockcroft-Gault or creatinine clearance (24 hours urine collection) in a cohort of 162 consecutive patients.
Results: Normal serum creatinine was observed in 46% patients. 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). According to Cockcroft-Gault formula stage 2 CKD i.e.GFR 60-89 ml/min was diagnosed in 92 patients (56.8%), and stage 3 CKD i.e. GFR 30-59ml/min was diagnosed in 62 patients (38.3%) and stage 4 CKD i.e. GFR 15-29ml/min was diagnosed in 14 patients (8.6%). According to MDRD formula stage 2 CKD was found in 157 patients (96.9%), stage 3 CKD was found in 105 patients (64.8%) and stage 4 in 28 (17.3%) patients. According to creatinine clearance stage 2 CKD was found in 145 patients (89.5%), stage 3 CKD was found in 135 patients (83.3%) and stage 4 was found in 21 (13.0%) patients. Clinically significant CKD (GFR<60ml/min) was found in 38.3%-83.3% depending on the formula used to estimate GFR or creatinine clearance.
Conclusions: The prevalence of CKD is extremely high in heart transplant recipients. Evaluation of renal function is important in order to select the appropriate strategy to reduce the cardiovascular risk.

Keywords: Heart Transplantation, Immunosuppression