Analysis of the prevalence and role of maladaptive left ventricular remodeling in the risk of early renal graft dysfunction

Objective: to study the prevalence of maladaptive left ventricular remodeling (MLVR) among kidney transplant (KT) candidates and the role of MLVR in the development of early graft dysfunction (EGD). Materials and methods. The study is based on a retrospective analysis of treatment outcomes in 650 patients who underwent a living related KT. Transthoracic echocardiogram revealed different types of left ventricular (LV) remodeling, whose prevalence was studied in the context of influence on the general population and specific «renal» risk factors. Two patient groups were also identified: Group I had EGD (n = 82) and Group II had primary graft function (PGF) (n = 79). These groups were comparable in terms of demographics, clinical data, and laboratory results (p > 0.1). The relative risk of developing EGD was calculated depending on whether maladaptive remodeling was present. Results. Concentric LV hypertrophy (cLVH) was detected in 341 (52.46%), eccentric (eLVH) in 174 (26.77%) patients. Concentric remodeling (CR) and normal LV geometry were detected in 86 (13.23%) and 49 (7.54%) patients, respectively. MLVR (cLVH + eLVH) was more common in men (p = 0.003). Compared to patients in the pre-dialysis stage, the risk of developing MLVR was 5.6 times higher for dialysis therapy durations up to 1 year, 8 times higher for durations 1 to 2 years, and 4.5 times higher for durations greater than 2 years (p < 0.05). The likelihood of developing MLVR was 8-fold higher in those with a functioning arteriovenous fistula (p < 0.001). As diuresis decreased, the odds of developing MLVR increased 4 to 15.8 times (p < 0.001). Depending on the severity of their anemia, patients with anemia had 2.7–13.8 times the chances of developing MLVR compared to those without anemia (p < 0.05). According to comparative analysis, the EGD group had a high prevalence of MLVR (p = 0.01). MLVR raised the risk of developing EGD in the post-transplant period by 8.5 times for cLVH (p = 0.049) and 14.5 times for eLVH (p = 0.011). Conclusion. The presence of MLVR in a KT candidate indicates the severity of cardiovascular disease brought on by progression of chronic kidney disease, and can also be regarded as one of the risk factors for EGD.

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