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and when&#160;they are&#44; it is often not clear whether&#160;or not they should be included on&#160;the waiting list&#46; Wali et al&#46;<span class="elsevierStyleSup">1 </span>evaluated&#160;the impact of transplant on 103&#160;patients with chronic heart failure&#160;and an EF of less than 40&#37;&#44; and&#160;they saw a clear improvement 12&#160;months after the transplant&#44; even in&#160;patients whose heart function was&#160;affected the most&#46; Kidney transplant should be considered in patients with&#160;heart failure&#44; since remaining on&#160;dialysis may result in progressive&#44;&#160;irreversible myocardial dysfunction&#46;&#160;Other studies also indicate that&#160;kidney transplant&#44; with all of the&#160;physiological changes that it entails&#160;and the way it corrects factors arising&#160;from uraemia&#44; can decrease and often&#160;resolve cardiac abnormalities secondary&#160;to chronic renal failure&#46; It reduces&#160;hypertrophy and dilation of the left&#160;ventricle and improves systolic and&#160;diastolic ventricular function&#46;<span class="elsevierStyleSup">2-4&#160;</span>Therefore&#44; the notable improvement&#160;in cardiac function after a kidney&#160;transplant reinforces the indication of&#160;transplants in these patients&#46;&#160;&#160;&#160;&#160;&#160;&#160;</p><p class="elsevierStylePara"><a href="grande&#47;10341108&#95;a21&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10341108_a21_f1.jpg" alt="Two-dimensional echo &#40;A and B&#41;&#44; apical two-chamber view&#44; showing the evolution of the different cavities in size and volume&#46; In the Doppler images below &#40;C and D&#41;&#44; we observe that mitral regurgitation practically disappears after the kidney transplant is "></img></a></p><p class="elsevierStylePara">Figure 1&#46; Two-dimensional echo &#40;A and B&#41;&#44; apical two-chamber view&#44; showing the evolution of the different cavities in size and volume&#46; In the Doppler images below &#40;C and D&#41;&#44; we observe that mitral regurgitation practically disappears after the kidney transplant is </p>"
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Effect of kidney transplant on ventricular dysfunction in a patient on haemodialysis
Efecto del trasplante renal en la disfunción ventricular de un paciente en hemodiálisis
J.A.. Quintanar Lartundoa, Gema Fernández Fresnedoa, B.. Ruiz Delgadob, M.. Ariasa
a Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander,
b Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander,
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He underwent&#160;additional testing including another&#160;ECG in February 2008&#44; which showed&#160;a systolic dysfunction of the left&#160;ventricle &#40;visual ejection fraction &#91;EF&#93;&#160;40&#37;&#44; telediastolic volume &#91;TDV&#93;&#160;157mm&#44; telesystolic volume &#91;TSV&#93;&#160;105mm&#44; a slight dilation of the left&#160;atrium with mild to moderate mitral&#160;regurgitation and severe pulmonary&#160;hypertension&#46; New ECGs were&#160;repeated in August and September&#160;2008&#44; and we observed a decrease of&#160;up to 25&#37; in systolic function&#44; loss of&#160;ventricular configuration with enddiastolic&#160;volume increasing to 185ml&#44;&#160;severe functional mitral regurgitation&#160;with increased atrial dilation and&#160;increase in the degree of pulmonary&#160;hypertension &#40;figure 1&#41;&#46; In November&#160;2008&#44; the patient underwent a kidney&#160;transplant with a good recovery&#44; and&#160;creatinine level at the time of&#160;discharge was 1&#46;5mg&#47;dl&#46; It was&#160;decided to close the AVF during the&#160;postoperative period&#46; In the months&#160;following the transplant the patient&#160;remained asymptomatic and the ECG&#160;parameters measured in July 2009 are&#160;better&#58; mitral regurgitation has&#160;disappeared completely&#44; EDV is&#160;129ml and the EF is 45&#37; &#40;figure 1&#41;&#46;&#160;Congestive heart failure is 12 to 36&#160;times more frequent in patients on&#160;dialysis than in the general&#160;population&#46; Proper treatment is a&#160;topic for debate&#46; It is not clear&#160;whether or not the general&#160;recommendations for treating heart&#160;failure in the general population are&#160;equally effective and safe in the&#160;population on dialysis&#46; Furthermore&#44;&#160;this patient group is at high surgical&#160;risk&#46; The lack of evidence on the&#160;effect of transplants on perioperative&#160;morbidity and mortality means that&#160;these patients are often not&#160;evaluated for transplant&#44; and when&#160;they are&#44; it is often not clear whether&#160;or not they should be included on&#160;the waiting list&#46; Wali et al&#46;<span class="elsevierStyleSup">1 </span>evaluated&#160;the impact of transplant on 103&#160;patients with chronic heart failure&#160;and an EF of less than 40&#37;&#44; and&#160;they saw a clear improvement 12&#160;months after the transplant&#44; even in&#160;patients whose heart function was&#160;affected the most&#46; Kidney transplant should be considered in patients with&#160;heart failure&#44; since remaining on&#160;dialysis may result in progressive&#44;&#160;irreversible myocardial dysfunction&#46;&#160;Other studies also indicate that&#160;kidney transplant&#44; with all of the&#160;physiological changes that it entails&#160;and the way it corrects factors arising&#160;from uraemia&#44; can decrease and often&#160;resolve cardiac abnormalities secondary&#160;to chronic renal failure&#46; It reduces&#160;hypertrophy and dilation of the left&#160;ventricle and improves systolic and&#160;diastolic ventricular function&#46;<span class="elsevierStyleSup">2-4&#160;</span>Therefore&#44; the notable improvement&#160;in cardiac function after a kidney&#160;transplant reinforces the indication of&#160;transplants in these patients&#46;&#160;&#160;&#160;&#160;&#160;&#160;</p><p class="elsevierStylePara"><a href="grande&#47;10341108&#95;a21&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10341108_a21_f1.jpg" alt="Two-dimensional echo &#40;A and B&#41;&#44; apical two-chamber view&#44; showing the evolution of the different cavities in size and volume&#46; In the Doppler images below &#40;C and D&#41;&#44; we observe that mitral regurgitation practically disappears after the kidney transplant is "></img></a></p><p class="elsevierStylePara">Figure 1&#46; Two-dimensional echo &#40;A and B&#41;&#44; apical two-chamber view&#44; showing the evolution of the different cavities in size and volume&#46; In the Doppler images below &#40;C and D&#41;&#44; we observe that mitral regurgitation practically disappears after the kidney transplant is </p>"
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Article information
ISSN: 20132514
Original language: English
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