COURSE OF LEFT-VENTRICULAR HYPERTROPHY AND FUNCTION IN END-STAGE RENAL-DISEASE AFTER RENAL-TRANSPLANTATION

Cardiovascular complications are frequent and related to left ventricular (LV) hypertrophy and dysfunction in end-stage renal disease. To examine cardiac changes after renal transplantation, 24 hemodialysis patients (18 men and 6 women, age 47 +/- 12 years) were analyzed in a prospective follow-up study with echocardiography immediately before and 41 +/- 30 months after renal transplantation. Mean systolic blood pressure (hemodialysis vs transplantation: 156 +/- 35 vs 144 +/- 15 mm Hg; p = not significant [NS]), as averages of 6 measurements from 2 weeks, remained constant and elevated. The most frequent echocardiographic findings at both assessments were left atrial dilatation (75 vs 79%; p = NS) and LV hypertrophy (71 vs 67%; p = NS). After transplantation, an increase was found in mean left atrial diameter (41 +/- 5 to 44 +/- 5 mm; p <0.05) and end-diastolic LV diameter (50 +/- 5 to 53 +/- 5 mm; p <0.05) at constant LV muscle mass (332 +/- 104 vs 329 +/- 94 g; p = NS). LV ejection fraction (58 +/- 10% to 63 +/- 12%; p <0.02) and stroke volume (98 +/- 26 to 118 +/- 25 ml; p <0.02) improved. No influence of blood pressure in sporadic morning determinations or of dialysis fistula patency on alterations of LV mass or function was found. Left atrial diameters increased in patients with patent dialysis fistulas (41 +/- 7 to 45 +/- 5 mm; p <0.05), but not in those with occluded fistulas (41 +/- 7 vs 42 +/- 4 mm; p = NS). The data suggest that systolic LV function improves after renal transplantation, whereas LV mass remains increased independent of the patency of a dialysis access. Whereas arterial blood pressure, as assessed with sporadic morning measurements, has no predictive value for changes of LV mass, the role of continuous 24-hour blood pressure control is yet to be determined.