1
|
Sharif A. Routine Cardiac Stress Testing in Potential Kidney Transplant Candidates Is Only Appropriate in Symptomatic Individuals: PRO. KIDNEY360 2022; 3:2008-2012. [PMID: 36591364 PMCID: PMC9802564 DOI: 10.34067/kid.0007592020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, United Kingdom,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
2
|
Mir T, Uddin M, Shah A, Khan MZ, Sheikh M, Rab T. ST elevation myocardial infarction and kidney transplant: A large cohort study: STEMI and renal transplant. J Cardiol 2021; 79:270-276. [PMID: 34565688 DOI: 10.1016/j.jjcc.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The literature on outcomes of ST-elevation myocardial infarction (STEMI) amongst kidney transplant recipients (KTR) is limited. OBJECTIVE To study the outcomes of STEMI among KTR. METHODS Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA were analyzed for hospitalizations with STEMI among KTR for the years 2012-2018. Complications associated with STEMI were extracted using International Classification of Diseases codes. RESULTS A total of 588,668 index KTR hospitalizations (mean age 57.67±14.22 years; female 44.5%) of which 3,496 (0.59%) had STEMI were recorded in the NRD for the years 2012-2018. A total of 11,676 (1.98%) patients died during the hospitalization. In-hospital mortality among STEMI was higher, 465 (13.3%), than without-STEMI 11,211 (1.92%). Among the complications, mechanical complications occurred among 1.0% vs 0.02%, cardiogenic shock 10.6 vs 0.3%, ventricular arrythmias 8.3% vs 0.8%, conduction block 6.9% vs 2%, stroke 4.1% vs 1.9%, and acute kidney injury 31.6% vs 28.3% among STEMI and without-STEMI respectively. Among coronary procedures, coronary angiography was performed among 1,999 (57.2%) of which 1,777 (50.8%) had percutaneous coronary intervention (PCI). On coarsened exact matching of baseline characteristics, PCI was less likely associated with mortality, odds ratio 0.39 (95% confidence interval 0.24-0.64; p=0.0002). The trends of mortality among STEMI were steady (p-trend 0.11). PCI trend increased (p-trend 0.008) and incidence of STEMI decreased over the study years 2012 (0.66%)-2018(0.474%). A total of 84,810 (14.4%) patients were readmitted in 30 days of which 696 (20%) patients were among the STEMI subgroup. CONCLUSION STEMI is not an uncommon complication among KTR and is associated with significant mechanical complications. Improvement in cardiovascular risk factors might improve the STEMI rates among KTR.
Collapse
Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States.
| | - Mohammed Uddin
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States
| | - Asif Shah
- Internal Medicine, Redmond Regional Medical Center, Rome, GA, United States
| | - Mohammad Zia Khan
- Division of Cardiology, University of Virginia, Morgantown, WV, United States
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica Toledo, Toledo, OH, United States
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, United States
| |
Collapse
|
3
|
Didier R, Yao H, Legendre M, Halimi JM, Rebibou JM, Herbert J, Zeller M, Fauchier L, Cottin Y. Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database. J Clin Med 2020; 9:jcm9103356. [PMID: 33086719 PMCID: PMC7589663 DOI: 10.3390/jcm9103356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.
Collapse
Affiliation(s)
- Romain Didier
- Department of Cardiology, University Teaching Hospital Burgundy, 21000 Dijon, France; (R.D.); (H.Y.)
| | - Hermann Yao
- Department of Cardiology, University Teaching Hospital Burgundy, 21000 Dijon, France; (R.D.); (H.Y.)
| | - Mathieu Legendre
- Department of Nephrology, University Teaching Hospital Burgundy, 21000 Dijon, France; (M.L.); (J.M.R.)
| | - Jean Michel Halimi
- Department of Nephrology, University Teaching Hospital of Trousseau and University François Rabelais University, 37000 Tours, France;
| | - Jean Michel Rebibou
- Department of Nephrology, University Teaching Hospital Burgundy, 21000 Dijon, France; (M.L.); (J.M.R.)
| | - Julien Herbert
- Department of Cardiology, University Teaching Hospital of Trousseau and EA7505, University François Rabelais University, 37000 Tours, France; (J.H.); (L.F.)
- Department of Informatics and Epidemiology, University Teaching Hospital of Trousseau and EA7505, University François Rabelais University, 37000 Tours, France
| | - Marianne Zeller
- PEC2 Research Team, EA 7460, Department of Health Sciences, University of Burgundy Franche Comté, 25000 Besançon, France;
| | - Laurent Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and EA7505, University François Rabelais University, 37000 Tours, France; (J.H.); (L.F.)
| | - Yves Cottin
- Department of Cardiology, University Teaching Hospital Burgundy, 21000 Dijon, France; (R.D.); (H.Y.)
- Correspondence: ; Tel.: +33-380-293-536; Fax: +33-329-3879
| |
Collapse
|
4
|
Choi H, Lee W, Lee HS, Kong SG, Kim DJ, Lee S, Oh H, Kim YN, Ock S, Kim T, Park MJ, Song W, Rim JH, Lee JH, Jeong S. The risk factors associated with treatment-related mortality in 16,073 kidney transplantation-A nationwide cohort study. PLoS One 2020; 15:e0236274. [PMID: 32722695 PMCID: PMC7386583 DOI: 10.1371/journal.pone.0236274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
Mortality at an early stage after kidney transplantation is a catastrophic event. Treatment-related mortality (TRM) within 1 or 3 months after kidney transplantation has been seldom reported. We designed a retrospective observational cohort study using a national population-based database, which included information about all kidney recipients between 2003 and 2016. A total of 16,073 patients who underwent kidney transplantation were included. The mortality rates 1 month (early TRM) and 3 months (TRM) after transplantation were 0.5% (n = 74) and 1.0% (n = 160), respectively. Based on a multivariate analysis, older age (hazard ratio [HR] = 1.06; P < 0.001), coronary artery disease (HR = 3.02; P = 0.002), and hemodialysis compared with pre-emptive kidney transplantation (HR = 2.53; P = 0.046) were the risk factors for early TRM. Older age (HR = 1.07; P < 0.001), coronary artery disease (HR = 2.88; P < 0.001), and hemodialysis (HR = 2.35; P = 0.004) were the common independent risk factors for TRM. In contrast, cardiac arrhythmia (HR = 1.98; P = 0.027) was associated only with early TRM, and fungal infection (HR = 2.61; P < 0.001), and epoch of transplantation (HR = 0.34; P < 0.001) were the factors associated with only TRM. The identified risk factors should be considered in patient counselling, selection, and management to prevent TRM.
Collapse
Affiliation(s)
- Hyunji Choi
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Woonhyoung Lee
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan, South Korea
| | - Da Jung Kim
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, South Korea
| | - Haeun Oh
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Department of Nephrology, Kosin University College of Medicine, Busan, South Korea
| | - Soyoung Ock
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Taeyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - John Hoon Rim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, South Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
- * E-mail:
| |
Collapse
|
5
|
Yadav V, Jha SC, Gajurel RM, Poudel CM, Sahi R, Sharma M, Adhikari S. <p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>. TRANSPLANT RESEARCH AND RISK MANAGEMENT 2020. [DOI: 10.2147/trrm.s261084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
6
|
Incidence, risk factors and prognostic impact of acute kidney injury after coronary angiography and intervention in kidney transplant recipients: a single-center retrospective analysis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:58-64. [PMID: 32368237 PMCID: PMC7189128 DOI: 10.5114/aic.2020.93913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidney transplant recipients (KTR) represent a high-risk population for cardiovascular disease. Coronary artery disease (CAD) is the most common cause of morbidity and mortality in this population. In KTR, coronary angiography and intervention (CI) can be associated with the risk of acute kidney injury (AKI). Aim Data about the incidence and impact of AKI after CI in this population are rare. The aim of the present study is to describe the incidence and risk factors of AKI, periprocedural bleeding and the prognostic impact on 1-year mortality in KTR undergoing CI. Material and methods This retrospective single-center study includes all KTR undergoing CI at University Hospital Frankfurt between 2005 and 2015. Results A total of 135 CIs in KTR were analyzed. AKI occurred in 31 of 135 CIs (23%, AKI group). Patients of the AKI group were older; other baseline characteristics did not show significant differences. The amount of contrast dye used was higher in the AKI group (p = NS). Periprocedural bleeding defined by BARC criteria occurred more often in the AKI group (23% vs. 5%, p < 0.01) and persisted as a risk factor of AKI in multivariate analysis (odds ratio = 6.43, 95% CI: 1.78–23.20, p = 0.01). In-hospital mortality was 3% in the AKI group; no patient of the non-AKI group died during hospitalization (p = 0.2). One-year-survival was significantly higher in the non-AKI group (94% vs. 81%, p = 0.02). Conclusions AKI is an important prognostic determinant in KTR undergoing coronary angiography and percutaneous coronary intervention (PCI). Periprocedural bleeding events were associated with AKI. Well-known risk factors for AKI such as contrast agent and diabetes were of minor impact.
Collapse
|
7
|
Rangaswami J, Mathew RO, Parasuraman R, Tantisattamo E, Lubetzky M, Rao S, Yaqub MS, Birdwell KA, Bennett W, Dalal P, Kapoor R, Lerma EV, Lerman M, McCormick N, Bangalore S, McCullough PA, Dadhania DM. Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies. Nephrol Dial Transplant 2020; 34:760-773. [PMID: 30984976 DOI: 10.1093/ndt/gfz053] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 12/19/2022] Open
Abstract
Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint 'cardio-nephrology' clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.
Collapse
Affiliation(s)
- Janani Rangaswami
- Einstein Medical Center, Philadelphia, PA, USA.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Roy O Mathew
- Columbia Veterans Affairs Health Care System, Columbia, SC, USA
| | | | | | - Michelle Lubetzky
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Swati Rao
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Rajan Kapoor
- Augusta University Medical Center, Augusta, GA, USA
| | - Edgar V Lerma
- UIC/Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Mark Lerman
- Medical City Dallas Hospital, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
8
|
Ghahrodi MS, Einollahi B, Baharvand A, Javanbakht M. Assessment of Short-term, Within Hospital Cardiovascular Complications After Renal Transplantation in Baqiyatallah Hospital. Mater Sociomed 2020; 31:241-245. [PMID: 32082086 PMCID: PMC7007615 DOI: 10.5455/msm.2019.31.241-245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Several studies have looked at cardiac complications in patients with end-stage renal disease (ESRD) after renal transplantation, but more attention has been paid to the long-term cardiovascular complications. Aim: The present study was designed to investigate the short-term cardiovascular complications of intrahospital hospitalization in post-renal transplant patients and related factors. Methods: In this retrospective cohort study, the medical records of all renal transplant patients in Baqiyatallah Hospital between 2015 and 2018 during the post-transplantation phase were investigated. Demographic data, transplantation type, cardiac risk factors, pre-operation cardiac consultation and para-clinical tests results were extracted from the patients’ records. The frequency and factors influencing the need for re-visitation as well as its final diagnosis were analyzed. Results: A total of 982 patients with a mean age of 13.73 ± 45.33 years were studied (62.6% males). In 39.8% of patients, cardiology re-visitation was required; of these 391 visits, only 162 patients (41.4%) had heart problems. In multivariate analysis, patients’ need for cardiac reconsideration was predicted by 7 variables; age, diabetes, history of CABG, ECG, echocardiography, angiography, and myocardial perfusion scan (R2 = 0.652, P <0.001). Furthermore, the five variables of first cardiology consultant, the first consultation physician, left ventricular hypertrophy, having history of angiography and myocardial perfusion scan, can predict the final diagnosis of cardiac problems in re-counseling (R2 = 0.188, P = 0.043). Conclusion: Given the high prevalence of need for a patient’s recurrent cardiac visit, it seems that risk assessment prior to kidney transplantation needs to be more accurate. It is recommended that elderly patients with abnormal findings in electrocardiography and echocardiography, having diabetes, having a history of negative coronary angiography or myocardial perfusion scan be more closely monitored for heart disease.
Collapse
Affiliation(s)
- Mohsen Sadeghi Ghahrodi
- Department of Cardiology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Baharvand
- Department of Cardiology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|