Open AccessChronic kidney disease after heart transplantation: a single‐centre retrospective study at Skåne University Hospital in Lund 1988–2010
Author(s) -
Söderlund Carl,
Löfdahl Eveline,
Nilsson Johan,
Reitan Öyvind,
Higgins Thomas,
Rådegran Göran
Publication year - 2016
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12710
Subject(s) - medicine , renal function , kidney disease , transplantation , incidence (geometry) , cumulative incidence , kidney transplantation , urology , proteinuria , heart transplantation , retrospective cohort study , cardiology , kidney , physics , optics
Summary We aimed to study the incidence, predictors and outcome of chronic kidney disease ( CKD ) after heart transplantation ( HT ). All our HT patients 1988–2010 were considered for inclusion. Of these, 134 came for annual follow‐ups including evaluation of glomerular filtration rate ( GFR ) using iohexol clearance measurements, and the CKD ‐ EPI (adults) or Schwartz (children) formulae. Median GFR (Q1–Q3) (ml/min/1.73 m 2 ) declined from 67.0 (50.0–82.0) during transplant assessment ( TA ) to 56.0 (45.0–69.0) at year 1, 53.0 (41.0–68.0) at year 5 and 44.5 (25.0–57.3) at year 10. The cumulative incidence of CKD ≥ stage 4 was 25% at 5 years and 41% at 10 years after transplantation. Proteinuria the first year post‐ HT was the only predictor related ( P < 0.05) to a higher rate of GFR decline ( HR 5.15, 95% CI 1.23–21.55). GFR ≥60 as compared to <60 before HT , or a first‐year GFR decline <30% as compared to >30%, was moreover associated ( P < 0.05) with a lower risk of death ( HR 0.30, 95% CI 0.12–0.76 and HR 0.35, 95% CI 0.13–0.90, respectively). Notably, the CKD ‐ EPI and Schwartz formulae overestimated GFR by 28 ± 29% and 26 ± 33%, respectively. In conclusion, CKD in HT patients is common and associated with worse outcome. To avoid diagnostic delay, GFR estimating equations' validity in HT patients needs further study.