Echocardiographic abnormalities in patients on kidney transplant waiting list.

BACKGROUND: Echocardiographic abnormalities are well described in chronic kidney disease (CKD), and associated with increased cardiovascular events (CVEs) and mortality. Little is known regarding progression of these abnormalities in patients awaiting kidney transplantation.

METHODS: We assessed the progression of echocardiographic variables in patients awaiting kidney transplantation and determined predictors of CVEs and mortality. The study included all patients awaiting kidney transplantation between 2004 and 2010 with repeat echocardiograms at least 1 year apart and at least 1 year after transplantation.

RESULTS: We assessed 79 patients (57% male, mean age 55 ± 11 years; 27% with diabetes). Sixty-three patients remained on waiting list, and 16 had kidney transplants. Two deaths and 2 CVEs occurred in patients awaiting kidney transplantation. Repeat echocardiograms (31 ± 19 months from baseline) on patients who remained on waiting list showed significant increases in left ventricular mass index (LVMI) (55.3 ± 17.8 vs. 60.5 ± 21.9 g/m2.7, p=0.02) and in left atrium (LA) diameter (3.8 ± 0.6 vs. 4.1 ± 0.8 cm, p=0.02). There were no significant changes in LV fractional shortening (FS) or LV end-systolic and end-diastolic dimensions. Left atrium diameter (p=0.005), systolic dysfunction (p=0.007) and LVMI (p=0.01) were independent predictors of CVEs and mortality.

CONCLUSIONS: Time on kidney transplant waiting list is associated with progressive increases in LA diameter and LVM, which are markers of adverse outcome.