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Cardiomyopathy in the Potential Kidney Transplant Candidate

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Cardio-Nephrology

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Abstract

Chronic kidney disease is a risk factor for cardiovascular disease and is an independent risk factor for development of cardiomyopathy even after controlling for coronary artery disease, hypertension, and diabetes. Congestive heart failure, both systolic and diastolic, in patients with end-stage renal disease is a poor prognostic marker with over 80% of patients dying within 3 years of the diagnosis. The pathophysiology of cardiomyopathy is thought to be a complex with multiple traditional risk factors (such as volume overload, hypertension, anemia) and nontraditional risk factors (such uremic toxin, inflammation, oxidative stress) being implicated. The current treatment approach is centered on treating both, the cardiomyopathy, and chronic kidney disease using guideline directed treatment algorithms focused on treating pressure and volume overload, anemia, secondary parathyroidism, and uremia. The field of transplant in patients with both congestive heart failure and end-stage renal disease is evolving. In the absence of genetic conditions or systemic infiltrative disease, most patients with isolated diastolic congestive heart failure may be listed for kidney transplantation. The work up of patients with systolic dysfunction is controversial due to a perceived high-risk candidacy. Consensus is lacking whether these patients should be listed for single organ or double organ heart/kidney transplantation. Although a majority of systolic heart failure patients will have improvement in their ejection fraction after kidney transplantation, a subset of patients has high mortality. The survival disadvantage is driven by patients who fail to improve their ejection fraction after kidney transplantation, suggesting a need for prospective trials to identify these patients.

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  1. Department of Internal Medicine, Rush University Medical Center, 1725 West Harrison St., Suite 1159, Chicago, IL, 60612, USA

    Burhan Mohamedali

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  1. Department of Internal Medicine, Einstein Medical Center, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Janani Rangaswami

  2. Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, USA

    Edgar V. Lerma

  3. Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

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Mohamedali, B. (2017). Cardiomyopathy in the Potential Kidney Transplant Candidate. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_26

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