Yonsei Med J.  2019 Mar;60(3):291-297. 10.3349/ymj.2019.60.3.291.

The Impact of Perioperative Factors on Changes in Diastolic Function after Kidney Transplantation: A Retrospective Analysis

• Kim EJ
• Koo BN
• Kim SY
• Huh KH
• Kang S
• Choi YS

• KMID: 2441307
• DOI: http://doi.org/10.3349/ymj.2019.60.3.291

Abstract

PURPOSE
Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT.
MATERIALS AND METHODS
We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e"²).
RESULTS
Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e"² after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e"² (odds ratio, −0.056; 95% confidence interval, −0.014 to −0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e"² changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029).
CONCLUSION
KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.

Keyword

Kidney transplantation; end-stage renal disease (ESRD); diastolic function

MeSH Terms

Cause of Death
Filtration
Humans
Kidney Failure, Chronic
Kidney Transplantation*
Kidney*
Renal Insufficiency, Chronic
Retrospective Studies*
Risk Factors

Figure

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  Fig. 1 Flow diagram of patients.

Reference

1. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15:2208–2218. PMID: 15284307.

2. Pecoits-Filho R, Bucharles S, Barberato SH. Diastolic heart failure in dialysis patients: mechanisms, diagnostic approach, and treatment. Semin Dial. 2012; 25:35–41. PMID: 22273530.

3. Losi MA, Memoli B, Contaldi C, Barbati G, Del Prete M, Betocchi S, et al. Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis. Nephrol Dial Transplant. 2010; 25:1950–1954. PMID: 20075436.

4. Glassock RJ, Pecoits-Filho R, Barberato SH. Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol. 2009; 4(Suppl 1):S79–S91. PMID: 19996010.

5. Hawwa N, Shrestha K, Hammadah M, Yeo PSD, Fatica R, Tang WHW. Reverse remodeling and prognosis following kidney transplantation in contemporary patients with cardiac dysfunction. J Am Coll Cardiol. 2015; 66:1779–1787. PMID: 26483101.

6. Ferreira SR, Moisés VA, Tavares A, Pacheco-Silva A. Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation. 2002; 74:1580–1587. PMID: 12490792.

7. Hewing B, Dehn AM, Staeck O, Knebel F, Spethmann S, Stangl K, et al. Improved left ventricular structure and function after successful kidney transplantation. Kidney Blood Press Res. 2016; 41:701–709. PMID: 27721315.

8. Wali RK, Wang GS, Gottlieb SS, Bellumkonda L, Hansalia R, Ramos E, et al. Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease. J Am Coll Cardiol. 2005; 45:1051–1060. PMID: 15808763.

9. Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Streather CP, et al. Mitral peak Doppler E-wave to peak mitral annulus velocity ratio is an accurate estimate of left ventricular filling pressure and predicts mortality in end-stage renal disease. J Am Soc Echocardiogr. 2006; 19:266–273. PMID: 16500488.

10. Higashi M, Yamaura K, Ikeda M, Shimauchi T, Saiki H, Hoka S. Diastolic dysfunction of the left ventricle is associated with pulmonary edema after renal transplantation. Acta Anaesthesiol Scand. 2013; 57:1154–1160. PMID: 23909639.

11. Kim EJ, Chang S, Kim SY, Huh KH, Kang S, Choi YS. Predictive value of echocardiographic abnormalities and the impact of diastolic dysfunction on in-hospital major cardiovascular complications after living donor kidney transplantation. Int J Med Sci. 2016; 13:620–628. PMID: 27499694.

12. El-Husseini AA, Sheashaa HA, Hassan NA, El-Demerdash FM, Sobh MA, Ghoneim MA. Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation. Pediatr Transplant. 2004; 8:249–254. PMID: 15176962.

13. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461–470. PMID: 10075613.

14. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012; 2:279–335.

15. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997; 30:474–480. PMID: 9247521.

16. Kim YJ, Sohn DW. Mitral annulus velocity in the estimation of left ventricular filling pressure: prospective study in 200 patients. J Am Soc Echocardiogr. 2000; 13:980–985. PMID: 11093099.

17. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29:277–314. PMID: 27037982.

18. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28:1–39. PMID: 25559473.

19. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997; 30:1527–1533. PMID: 9362412.

20. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000; 102:1788–1794. PMID: 11023933.

21. Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P, et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006; 21:125–132. PMID: 16221719.

22. Ryu T, Song SY. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist’s perspective. Korean J Anesthesiol. 2017; 70:3–12. PMID: 28184260.

23. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014; 64:e77–137. PMID: 25091544.

24. Ybarra J, Sánchez-Hernández J, Vilallonga R, Romeo JH. Differential associations between glomerular filtration rate and duration of obesity depending on the presence or absence of left ventricular diastolic dysfunction. Eur J Intern Med. 2016; 32:47–52. PMID: 26935097.

25. Calleja AM, Rakowski H, Williams LK, Jamorski M, Chan CT, Carasso S. Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end-stage renal disease. Echocardiography. 2016; 33:1495–1503. PMID: 27352813.