Time-dependent changes in cardiac growth after kidney transplantation:: the impact of pre-dialysis ventricular mass

Background. Left ventricular hypertrophy ( LVH) is common in chronic kidney disease ( CKD), including kidney transplant recipients. However, time- related left ventricular mass changes ( Delta LVM) from pre- dialysis stage to beyond the first post- transplant year have not been clearly identified. Methods. We studied a cohort of 60 stages 4 - 5 CKD patients without overt cardiac disease, who underwent three echocardiograms during follow- up: at pre- dialysis stage, on dialysis and after kidney transplantation ( KT). Multiple linear regression was used to model Delta LVM from baseline study. Cox proportional analysis was used to determine risk factors associated with either de novo LVH or > 20% Delta LVMI over time. Results. Patients with baseline LVH ( n=37; 61%) had a higher body mass index ( BMI) than those without LVH (n=23; 39%) (P=0.013). BMI, haemoglobin levels (P=0.047) and non- use of angiotensin- converting enzyme inhibitors ( ACEI) (P=0.057) were associated with baseline left ventricular mass index ( LVMI). Twelve out of 23 patients ( 52%) with normal LVM at baseline, developed either de novo LVH or > 20% Delta LVMI at follow- up. On the other hand, 29 ( 78%) of those with initial LVH maintained this abnormality, and 8 ( 22%) normalized LVM post- transplantation. Factors associated with Delta LVMI were age (P=0.01), pre- dialysis LVMI ( P< 0.0001), serum creatinine ( P=0.012) and the use of ACEI post- transplantation (P=0.009). In Cox analysis, pre- dialysis LVMI was associated with de novo LVH or > 20% Delta LVMI over time ( hazard ratio 1.009; 95% confidence interval 1.004 to 1.015; P 0.001). Conclusions. Successful KT may not completely normalize LVM post- transplantation. Pre- dialysis LVMI, traditional risk factors and no use of ACEI may perpetuate cardiac growth following KT.