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Kidney Week

Abstract: TH-PO476

High Prevalence of Significant Structural Heart Disease by Echocardiography in Patients Undergoing Evaluation for Kidney Transplantation

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Aktan, Idil, University of Virginia, Charlottesville, Virginia, United States
  • Holsten, Laura, University of Virginia, Charlottesville, Virginia, United States
  • Mazimba, Sula, University of Virginia, Charlottesville, Virginia, United States
  • Mihalek, Andrew D., University of Virginia, Charlottesville, Virginia, United States
  • Le, Thu H., University of Virginia, Charlottesville, Virginia, United States
  • Bowman, Brendan T., University of Virginia, Charlottesville, Virginia, United States
  • Doyle, Alden Michael, University of Virginia, Charlottesville, Virginia, United States
  • Kennedy, Jamie L w, University of Virginia, Charlottesville, Virginia, United States
Background

Although the deleterious effect of structural heart disease in patients with advanced kidney disease is well known, the specific contribution of valvular abnormalities has been less well characterized. Detailed echocardiographic criteria have been proposed by the Acute Dialysis Quality Initiative XI Workgroup to identify dialysis patients with underlying structural heart disease. We sought to determine the prevalence of structural heart disease, including valvular disease, in a single center cohort of dialysis patients referred for kidney transplant evaluation.

Methods

We performed a retrospective analysis of single center echocardiographic data obtained from patients undergoing kidney transplant evaluation from 2006 to 2018. Studies that took place at least six months after initiating dialysis were included. Analyses were performed with SAS using Chi square, ANOVA, or Fisher’s exact test.

Results

Patients undergoing initial kidney transplant evaluation at the University of Virginia were evaluated by echocardiography, n = 461. They were 58.6% men, and median age was 58 years, interquartile range (IQR) 48 - 66. Median duration of dialysis was 29 months, IQR 17 - 50. Comorbidities included hypertension (89.6%), diabetes (55.8%), and coronary disease (21.7%). The table below shows the frequency of cardiac disease by transplant status at the time of data collection. There were no cases of significant mitral or tricuspid stenosis, and no significant pulmonic valve pathology.

Conclusion

Prevalence of structural heart disease in patients referred for kidney transplant evaluation is high. Patients who ultimately underwent kidney transplant had significantly lower prevalence of structural heart disease, including mitral regurgitation, aortic stenosis, and tricuspid regurgitation, compared to non-transplanted patients.

Echocardiographic ParameterOverall Cohort (n=461)Transplanted Patients (n=266)Actively Listed (n=106)Expired (n=62)Inactive (n=27)P value
Left ventricular dysfunction (EF ≤ 45%) (%)17.576.0215.0956.4551.85< 0.0001
Right ventricular dysfunction (mild or worse) (%)15.583.8122.8641.9429.63< 0.0001
Mitral regurgitation (moderate or worse) (%)4.31.612.8616.137.41< 0.0001
Aortic stenosis (moderate or worse) (%)3.090.554.1211.3200.0016
Aortic regurgitation (moderate or worse) (%)0.510.48003.70.2168
Tricuspid regurgitation (moderate or worse) (%)7.052.046.627.427.41< 0.0001
Pulmonary hypertension (estimated PASP ≥ 50 mm Hg) (%)8.241.1314.1524.1918.52< 0.0001
Left ventricular hypertrophy (IVS or PWD ≥ 1.2 cm)53.858.6548.115037.040.0628