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1.
Am J Transplant ; 8(2): 446-51, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18190661

RESUMO

Ventricular repolarization heterogeneity (VRH) is associated with the risk of arrhythmia and cardiac death. This study investigated the association between VRH and left ventricular mass (LVM) in renal transplant recipients 1 year after transplantation. Echocardiography and 5-min 12-lead electrocardiogram were recorded and GFR was estimated (eGFR) in 68 nondiabetic patients. Beat-to-beat QT interval variability algorithm was used to calculate SDNN-QT and rMSSD-QT indices of VRH. To quantify QT interval variability relative to heart rate fluctuations, QTRR index was calculated. Left ventricular hypertrophy (LVH) was present in 44 patients (65%). LVM and incidence of LVH were increased in 28 patients with eGFR <60 mL/min/1.73 m(2) compared with 40 patients with eGFR > or =60 mL/min/1.73 m(2) (248 +/- 61 g and 86% vs. 210 +/- 46 g and 50%, respectively; p < 0.01). A direct correlation was found between LVM and SDNN-QT (R = 0.47, R(2)= 0.23; p < 0.001), rMSSD-QT (R = 0.27; R(2)= 0.10; p = 0.034), and QTRR (R = 0.55; R(2)= 0.31; p < 0.001) indices. In conclusion, greater LVM is associated with increased VRH in renal transplant recipients, providing a link with the high risk of arrhythmia and cardiac death, specifically in patients with decreased graft function.


Assuntos
Ventrículos do Coração/anatomia & histologia , Transplante de Rim/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Arritmias Cardíacas/epidemiologia , Pressão Sanguínea , Morte Súbita Cardíaca , Feminino , Seguimentos , Taxa de Filtração Glomerular , Frequência Cardíaca , Humanos , Nefropatias/classificação , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Terapia de Substituição Renal , Disfunção Ventricular Esquerda/complicações
2.
Transplant Proc ; 40(5): 1357-61, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18589105

RESUMO

Elevated serum concentrations of soluble CD30 molecule (sCD30) have been related to acute cellular rejection and poor graft outcomes in kidney transplantation. This historical cohort study investigated the association of pretransplant sCD30 serum concentrations with kidney graft function expressed as estimated glomerular filtration rate (GFR) at 3 years after transplantation. Pretransplant sera from 176 adult deceased-donor kidney graft recipients were tested for sCD30 content using a commercially available automated enzyme-linked immunosorbent assay. The immunosuppression consisted of induction therapy with monoclonal anti-CD25 antibodies and a maintenance regimen of cyclosporine (CsA)-based therapy. GFR was estimated (eGFR) by the four-variable Modification of Diet in Renal Disease (MDRD) Study equation. According to the distribution of pretransplant sCD30 levels (median 66.7 U/mL; interquartile range, 46.6 to 98.6 U/mL), a concentration of 66 U/mL or higher was defined as high (n = 89) and below 66 U/mL as low (n = 87). Three years after transplantation, eGFR was not significantly different among recipients in high versus low sCD30 groups (69 +/- 23 mL/min/1.73m2 vs 66 +/- 21 mL/min/1.73m2; P = .327) and there was no correlation between eGFR and pretransplant sCD30 levels (r2 = 0.001; P = .73). Upon multivariate regression analysis, donor age, recipient body mass index at transplantation, and acute rejection episodes were independent variables affecting eGFR at 3 years after transplantation. This study showed that pretransplant sCD30 serum concentrations were not associated with deceased-donor kidney graft function at 3 years after transplantation. The immunosuppression with anti-CD25 antibodies and a triple CsA-based maintenance regimen could possibly be decisive for our findings.


Assuntos
Antígeno Ki-1/sangue , Transplante de Rim/fisiologia , Adolescente , Adulto , Antígenos CD/sangue , Antígenos CD/imunologia , Cadáver , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Antígeno Ki-1/imunologia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Linfócitos T/imunologia , Fatores de Tempo , Doadores de Tecidos
3.
Transplant Proc ; 39(10): 3093-7, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18089329

RESUMO

In this prospective, randomized, open-label, single-center study, we compared the efficacy and safety of two anti-interleukin-2 receptor monoclonal antibodies among adult recipients of at least 1 HLA-mismatched deceased donor renal grafts. Eligible patients were randomized to induction with either basiliximab or daclizumab. Both groups received cyclosporine microemulsion (CsA Neoral), mycophenolate mofetil, and methylprednisolone. An intent-to-treat analysis of 1-year data assessed the incidence of acute rejection episodes, the renal graft function, the safety, and the patient and graft survivals. Among 127 patients, six (10.0%) and seven (11.5%) patients experienced biopsy-confirmed acute rejection at 12 months, in the basiliximab and the daclizumab groups, respectively. Two renal grafts were lost in the basiliximab and six in the daclizumab cohort, one of them due to rejection. One basiliximab and two daclizumab patients died. Hospital treatment was required for 25 and 33 infections in basiliximab and daclizumab groups, respectively. One basal cell carcinoma of skin was detected. One hypersensitivity reaction was observed with daclizumab. At 12 months, serum creatinine was 101+/-28 micromol/L with basiliximab and 109+/-41 micromol/L with daclizumab. Patient survival was 98.4% with basiliximab and 96.7% with daclizumab, and graft survival was 96.8% versus 90.8%, respectively. No significant differences were observed between the groups. Basiliximab or daclizumab combined with triple therapy was an efficient and safe immunosuppression strategy, demonstrated with low incidence of acute rejection episodes, an acceptable adverse event profile, excellent graft function, and high survival rates in adult recipients within the first year after deceased donor renal transplantation.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Proteínas Recombinantes de Fusão/uso terapêutico , Doadores de Tecidos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Basiliximab , Ciclosporina/sangue , Ciclosporina/uso terapêutico , Daclizumabe , Quimioterapia Combinada , Feminino , Teste de Histocompatibilidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Segurança , Resultado do Tratamento
4.
Transplant Proc ; 38(9): 2853-5, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17112847

RESUMO

We studied prospectively the efficacy and safety of basiliximab combined with triple immunosuppression in adult recipients of > or = 1 HLA-mismatched deceased donor renal grafts. All studied patients received equal immunosuppressive drugs: 20 mg infusion of basiliximab on day 0 and on day 4, cyclosporine microemulsion (Neoral), mycophenolate mofetil, and methylprednisolone. An analysis of 1-year data assessed the incidence of acute rejection episodes, safety of this therapy, renal graft function, and patient and graft survivals. One hundred seventy-two patients were studied. The HLA-antigen mismatches were 2.9 +/- 0.9 (mean +/- SD), and the cold ischemia time was 22.0 +/- 7.5 hours. Fifty-three (31.5%) patients experienced delayed graft function. At 12 months, 5 (3.0%) patients experienced acute rejection. Six renal grafts were lost, but not from rejection. Two patients died. Sixty-six infections required treatment in the hospital. One carcinoma of cervix (in situ) and two basal cell carcinomas of skin were detected. Hypersensitivity reactions and cytokine-release syndrome were not observed. At 12 months, serum creatinine was significantly higher (119 +/- 46 micromol/L; P < .001) in patients with delayed graft function than in patients with immediate graft function (99 +/- 26 micromol/L). Patient and graft survivals were 98.8% and 97.1%, respectively. Basiliximab combined with this triple therapy was an efficient and safe immunosuppression strategy, demonstrated with very low incidence of acute rejections, an acceptable adverse event profile, excellent graft function, and high short-term survival rates in adult recipients of deceased donor renal transplant.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Proteínas Recombinantes de Fusão/uso terapêutico , Adolescente , Adulto , Idoso , Basiliximab , Quimioterapia Combinada , Feminino , Teste de Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/estatística & dados numéricos
5.
Adv Exp Med Biol ; 212: 265-71, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-3618362

RESUMO

From the beginning of 1974 to the end of 1985 141 persons in Slovenia (population 1.9 million) contracted leptospirosis 49 patients were 50 years old or more. All the patients have survived. 8 male patients aged from 18 to 44 had more severe acute renal failure (ARF), 5 of whom were treated with hemodialysis. The authors found that this 100% survival rate did not agree with the findings of many other researches which quote a relatively high mortality rate among older patients. In all 8 patients kidney function was good 1 year or more after ARF. The authors consider that the survival of patients with ARF depends on early and appropriate supportive treatment, which also includes intensive hemodialysis.


Assuntos
Injúria Renal Aguda/etiologia , Leptospirose/complicações , Injúria Renal Aguda/terapia , Adolescente , Adulto , Feminino , Humanos , Leptospirose/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Iugoslávia
6.
Int J Artif Organs ; 13(3): 169-75, 1990 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-2347665

RESUMO

Continuous ambulatory peritoneal dialysis (CAPD) has become an accepted alternative to chronic hemodialysis in the treatment of end-stage renal disease. The method utilizes the diffusion of drugs from the blood through the peritoneal membrane to the peritoneal cavity if administered intravenously (IV) and perorally (PO) and in the opposite direction if applied intraperitoneally (IP). The present work uses an open, two-compartment pharmacokinetic model reversibly linked with the compartment representing the peritoneal cavity and an analog-hybrid computer to simulate drug levels in sampled and unsampled compartments under conditions of various routes of administration (IV, IP and sequential IV, IP and PO) and different clinical status (presence and absence of peritonitis). The drug chosen for simulation was ciprofloxacin (CIP), a new synthetic antibacterial agent of the 4-quinolone group. Eight patients were included in the study, and CIP concentrations in plasma and dialysate were obtained by HPLC analysis to assess the reliability of the model and the efficiency of the sequential dosing scheme. CIP plasma and dialysate levels were adequate for the majority of microbes causing CAPD peritonitis. The proposed regimen was efficient in 85% of cases.


Assuntos
Ciprofloxacina/farmacocinética , Simulação por Computador , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Administração Oral , Adulto , Idoso , Ciprofloxacina/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Cavidade Peritoneal , Peritonite/tratamento farmacológico , Peritonite/metabolismo , Projetos Piloto
7.
Int J Artif Organs ; 14(8): 515-7, 1991 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1937941

RESUMO

To check whether in vivo EDTA prevents complement activation resulting from blood contact with the dialyzer membrane, sham hemodialysis (HD) was performed in seven healthy volunteers using Cuprophan hollow-fiber dialyzers. Blood samples were drawn from the arterial and venous blood lines of the dialyzer before and after EDTA was infused into the arterial line. Venous line plasma C3a concentrations before EDTA infusion were significantly higher than after EDTA. Also, venous line plasma C3a concentrations before and after EDTA infusion were significantly higher than in the arterial line. These results indicate that complement activation can be attenuated by EDTA during sham HD. Technical improvements in the procedure may permit complete inhibition of complement activation.


Assuntos
Ativação do Complemento/efeitos dos fármacos , Complemento C3a/análise , Ácido Edético/farmacologia , Diálise Renal/instrumentação , Adulto , Celulose/análogos & derivados , Feminino , Humanos , Rins Artificiais , Masculino , Membranas Artificiais
8.
Adv Perit Dial ; 10: 144-6, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7999813

RESUMO

This prospective randomized study is an evaluation of efficacy of cefazolin and ofloxacin in 23 end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) who experienced 38 episodes of peritonitis (P). Cefazolin was administered intraperitoneally: 1000 mg as loading dose and 250 mg every exchange as maintenance dose for ten days. Ofloxacin was given orally: first 300 mg, followed by ten daily doses of 200 mg. Microbes most frequently isolated from peritoneal effluent were Staphylococci (coagulase-negative in 55.3%, aureus in 7.9%), Acinetobacter (in 5.3%), Klebsiella (in 5.5%), and Micrococcus (in 5.3%). Used as monotherapy, we found the efficacy of both cefazolin and ofloxacin inadequate for treatment of P in CAPD patients (cefazolin 65%, ofloxacin 67%) (NS).


Assuntos
Cefazolina/uso terapêutico , Ofloxacino/uso terapêutico , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/microbiologia , Estudos Prospectivos
9.
Adv Perit Dial ; 13: 218-20, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9360685

RESUMO

In spite of several recommendations, choosing the initial antibiotic to treat continuous ambulatory peritoneal dialysis (CAPD) peritonitis remains difficult. In our prospective randomized study we attempted to evaluate the efficacy and safety of less toxic combinations of cephalosporins with vancomycin or netilmycin. From November 1993 to September 1996 we treated 52 episodes of peritonitis in 34 patients. Peritonitis was diagnosed according to the valid criteria. Patients were treated for 14 - 28 days with a combination of either cefazolin plus netilmycin or vancomycin plus ceftazidime. The most frequent bacteria causing peritonitis in the two groups were comparable. The efficacy of the cefazolin/netilmycin combination was 91.6% (22/24) without yeasts and 84.0% (21/25) in the vancomycin/ceftazidime combination. There were no statistically significant differences between the two otherwise efficient combinations of antibiotics. No side effects were observed. We believe that the frequent use of vancomycin could be avoided thus reducing the risks of resistance and ototoxicity.


Assuntos
Quimioterapia Combinada/uso terapêutico , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/tratamento farmacológico , Cefazolina/administração & dosagem , Ceftazidima/administração & dosagem , Humanos , Pessoa de Meia-Idade , Netilmicina/administração & dosagem , Peritonite/etiologia , Peritonite/microbiologia , Estudos Prospectivos , Falha de Tratamento , Vancomicina/administração & dosagem
10.
Adv Perit Dial ; 11: 149-51, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8534690

RESUMO

To analyze peritoneal catheter infections (PCIs), primarily the type (acute or chronic), frequency, and therapeutic outcome, we assessed 113 patients treated between January 1992 and December 1994. The average age was 56.3 +/- 15.3 years, and 38% were diabetics. One hundred and thirty peritoneal catheters (PCs) were placed surgically in the lateral abdominal wall. The peritonitis rate fell from 0.61 episodes/year to 0.33 episodes/year, but the exit-site and/or tunnel infection (ESI/TI) rate increased (from 0.48 episodes/year to 0.61 episodes/year). Seventy-nine cases of PCI were observed; 58 (73.4%) were acute ESI/TI and 21 (26.6%) were exacerbations of chronic ESI/TI. Thirty-one (53.4%) acute PCIs were cured, 17 (29.3%) became persistent, and in 10 (17.2%) cases the PC was removed. In chronic ESI/TI, of the 21 exacerbations registered, in 12 cases (57.1%) conservative treatment was effective, while in 9 cases (42.9%) the PC was removed. We conclude that ESI/TIs are the most frequent type of continuous ambulatory peritoneal dialysis (CAPD) infection and the more frequent cause of PC removal compared to peritonitis (p < 0.001). PC removal is more frequent in chronic than in acute ESI/TI (p < 0.005). The progression of infection towards the external and even the internal cuff is a poor prognostic sign. Staphylococcus aureus and Pseudomonas aeruginosa were the most common causes of infection and the most serious infective agents, causing chronic infection or catheter removal. Clinical evaluation of ESI/TI can be helped significantly by ultrasound examination, which is 100% positive in chronic ESI/TI and not more than 52.1% positive in acute ESI/TI (p < 0.005).


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Cateteres de Demora/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Peritoneal , Peritonite/etiologia , Estudos Prospectivos , Resultado do Tratamento
11.
Wien Klin Wochenschr ; 112(15-16): 692-701, 2000 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-11020959

RESUMO

In addition to the conventional World Health Organization (WHO) classification of lupus glomerulonephritis (GN), various concomitant approaches have been introduced in the evaluation of renal biopsies of patients with systemic lupus erythematosus (SLE) in order to increase the impact of biopsies on the decision concerning the most appropriate therapy as well as for establishing the prognosis. Three hundred and seventy kidney tissue samples from 267 SLE patients were analysed using standardised light, electron and immunofluorescence microscopic techniques. In 155 patients, a comparative clinical follow-up study and statistical analysis were performed. The study highlighted the heterogeneity of WHO classes IV and III, which include 5 and 6 different conventional histomorphologic types of GN, respectively. Mixed membranous and proliferative GN associated with "full-house" mesangial-transmembranous immune deposits, demonstrated in more than one third of our SLE cases, appears to be diagnostically most characteristic. Immune deposits distributed in the glomeruli in five different patterns, obviously play a major role in the pathogenesis of various WHO classes and histomorphologic types of lupus GN. Additional mechanisms related to the occurrence of antiphospholipid antibodies and antineutrophil cytoplasmic antibodies are suggested to contribute to the histomorphologic heterogeneity of WHO class III and IV lupus GN, particularly to the development of thrombotic, necrotising and crescentic glomerular lesions. In the present study, a statistically significant association was demonstrated between increasing mean values of the activity index and glomerular deposit distribution patterns labeled by subendothelial deposits. Furthermore, a significant correlation was established between an increasing risk of developing renal failure and increasing mean values of the chronicity index. Differences in the increasing risk of developing renal failure between groups with different histomorphologic types of GN and different immune deposit distribution patterns were not statistically significant. The surprisingly high renal survival rate of more than 80% noted in lupus patients with predominantly necrotising crescentic GN during the mean follow-up period of 40 months appears to be related to the more aggressive treatment of those patients. Our study confirmed a significant role of the WHO classification of lupus GN in the decision concerning the most appropriate treatment and prognostication. An increasing risk of irreversible renal failure in patients with WHO class IV lesions in contrast to those of WHO class III and in contrast to those of the category incorporating all other WHO classes was shown to be statistically significant.


Assuntos
Glomérulos Renais/imunologia , Glomérulos Renais/patologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/patologia , Adolescente , Adulto , Idoso , Complexo Antígeno-Anticorpo/ultraestrutura , Biópsia , Capilares , Criança , Pré-Escolar , Doença Crônica , Endotélio Vascular/imunologia , Endotélio Vascular/patologia , Feminino , Seguimentos , Humanos , Glomérulos Renais/ultraestrutura , Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica/imunologia , Nefrite Lúpica/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Organização Mundial da Saúde
12.
Comput Biol Med ; 33(3): 197-202, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12726798

RESUMO

A simple computer program was made to draw different left ventricle shapes in order to support the theory of elongation and to get a visual presentation of the shape of the left ventricle. Experimental data, obtained from echocardiography and Simpson's rule, were used for this program. The results yielded different shapes under different physiological circumstances, indicating the sensitivity of the method. It was concluded that these figures (shapes) support the use of elongation as a shape index.


Assuntos
Simulação por Computador , Modelos Cardiovasculares , Função Ventricular Esquerda/fisiologia , Função Ventricular , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/fisiopatologia
13.
Transplant Proc ; 42(10): 4043-6, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21168622

RESUMO

INTRODUCTION: An elevated serum concentration of soluble the form of CD30 (sCD30), an activation marker of mainly T(H)2-type cytokines producing T lymphocytes, has been reported as a predictive factor for acute cellular rejection episodes and poor graft outcomes in kidney transplantation. This historic cohort study investigated the association of a pretransplant sCD30 serum concentrations with kidney graft function and graft survival 3 years posttransplantation in adult recipients of deceased donor kidney grafts, treated with monoclonal anti-CD25 antibodies as an induction treatment combined with a cyclosporine (CsA)-based maintenance triple therapy. MATERIALS AND METHODS: The pretransplant sera of 296 recipients were tested for sCD30 content using a microsphere flow-cytometry assay. The estimated glomerular filtration rate (eGFR) was determined by the 4-variable Modification of Diet in Renal Disease equation. The incidences of graft loss were calculated with the use of Kaplan-Meier survival analysis and compared using the log-rank test. RESULTS: According to the distribution of the pretransplant sCD30 levels concentration ≥2700 pg/mL was defined as high (n = 146) and concentration <2700 pg/mL as low (n = 150). Three years posttransplantation, the eGFR was not significantly different in the recipients in high and low sCD30 groups (65 ± 24 vs 67 ± 21 mL/min/1.73 m(2); P = .43); there was no association between the eGFR 3 years after transplantation and the pretransplant sCD30 levels (r(2) = 0.002; P = .49). Graft survival 3 years after transplantation was also not different in the recipients in high and low sCD30 groups (P = .52). CONCLUSION: In our adult deceased-donor kidney graft recipients, the pretransplant sCD30 serum concentration was not a predictive factor of immunologic risk associated with the kidney graft function 3 years posttransplantation; neither did it affect graft survival 3 years after transplantation. The immunosuppression with anti-CD25 antibodies as an induction treatment combined with the CsA-based maintenance triple therapy could possibly be decisive for our findings.


Assuntos
Sobrevivência de Enxerto , Antígeno Ki-1/sangue , Transplante de Rim , Adulto , Anticorpos Monoclonais/administração & dosagem , Estudos de Coortes , Ciclosporina/administração & dosagem , Feminino , Citometria de Fluxo , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
14.
Transplant Proc ; 42(10): 4064-8, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21168628

RESUMO

Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. Increased left ventricular mass (LVM) is a risk factor for CVE. This study investigated the associations of LVM with impaired kidney graft function expressed as lower glomerular filtration rate (GFR) at 1 year after transplantation and future CVE beyond 1 year. The prospective study cohort included 68 nondiabetic recipients of a kidney transplant between January 2004 and December 2005 who underwent a transthoracic echocardiographic investigation at 1 year after transplantation. LVM and left ventricular hypertrophy (LVH) were assessed using 2-dimensional M-mode echocardiography. GFR was estimated (eGFR) by the 4-variable Modification of Diet in Renal Disease formula. Cox proportional hazards analysis was used to estimate cardiac CVE (angina pectoris, acute myocardial infarct, coronary angioplasty or bypass surgery, or sudden cardiac death) hazard ratios (HRs) for patients with LVH versus control subjects with no LVH at 1 year after transplantation. All patients had normal systolic function (ejection fraction >50%) with no symptoms or signs of heart failure. LVH was present in 44 patients (65%). LVM and incidence of LVH were increased in 28 patients with eGFR <60 mL/min/1.73 m(2) compared with 40 patients with eGFR ≥60 mL/min/1.73 m(2) (248 ± 61 g and 86% vs 210 ± 46 g and 50%, respectively; P < .01). After a median follow-up of 4.5 years, there were 18 (26.5%) cardiac CVE. The incidence of CVE was higher in patients with LVH than in patients with no LVH at 1 year after transplantation (36.4% vs 8.3%; P = .020). In adjusted analyses, LVH was associated with an increased risk for future CVE (HR, 4.69; 95% confidence interval, 1.02-21.5; P = .037). In kidney transplant recipients, a lower eGFR at 1 year after transplantation was associated with greater LVM and higher incidence of LVH. Presence of LVH was associated with an increased risk for future CVE.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Sobrevivência de Enxerto , Ventrículos do Coração/diagnóstico por imagem , Transplante de Rim , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Ultrassonografia
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