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Early decline in kidney function following heart transplantation predictor of death, dialysis, study shows

Wednesday, February 04 2009 | Comments

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What's This? An early decline in estimated creatinine clearance (CrCl) within the first year following heart transplantation is a strong predictor of chronic dialysis and mortality >1 year after the procedure, according to recently published study results.

Chronic kidney disease (CKD) continues to be a significant, unsolved complication of heart transplantation, the authors explained.

To determine whether an early decline in kidney function could be a predictor of progression to end-stage renal disease (ESRD) following heart transplantation, the researchers conducted a retrospective cohort study of 233 patients who underwent the procedure between July 1985 and July 2004 and who survived >1 month.

The investigators examined the relationship between various traditional risk factors (sex, age, and the presence of hypertension, diabetes, or primary cardiac disease) and renal dysfunction outcomes, including CrCl <=30 mL/min and chronic dialysis posttransplantation. The relationship between these factors and long-term mortality following the transplantation also was studied.

Of the 227 patients who survived >3 months after the procedure, 17 required chronic dialysis. Of the 214 patients who survived >1 year, 116 deaths occurred (mean time to death, 8.77 yrs).

A multivariate analysis revealed that a CrCl decline of >=30% in months 1 to 3 and a CrCl decline of >=30% in months 1 to 12 were significant predictors of chronic dialysis (P=.04 and P=.01, respectively).  A CrCl decline of >=30% during months 1 to 3 or during months 1 to 12 was also a significant predictor of time to first CrCl <=30 mL/min at >1 year posttransplantation (P=.01 and P=.02, respectively).

Further, a CrCl decline of >=30% in months 1 to 12 was a statistically significant predictor of all-cause mortality (P<.0001).

Traditional risk factors--sex, age, or the presence of primary cardiac disease--were not associated with kidney disease progression, the authors noted.

"Our results should be further explored in a prospective study, and if validated, these early markers of kidney function could be used to guide the implementation of renal protective strategies in patients at a higher risk of adverse outcomes related to CKD," they concluded. (Cantarovich M, et al. Am J Transplant 2009;9:348-354.)

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