Left ventricular remodeling and its association with mineral and bone disorder in kidney transplant recipients

Abstract

Background

The assessment of left ventricular (LV) remodeling and its association with mineral and bone disorder (MBD) in kidney transplant recipients (KTRs) have not been systematically studied. We aimed to evaluate LV remodeling changes one year after kidney transplantation (KT) and identify their influencing factors.

Methods

Ninety-five KTRs (68 males; ages 40.2 ± 10.8 years) were followed before and one year after KT. Traditional risk factors and bone metabolism indicators were assessed. Left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and left ventricular diastolic dysfunction (LVDD) were measured using two-dimensional transthoracic echocardiography. The relationship between MBD and LV remodeling and the factors influencing LV remodeling were analyzed.

Results

One year after KT, MBD was partially improved, mainly characterized by hypercalcemia, hypophosphatemia, hyperparathyroidism, 25-(OH) vitamin D deficiency, elevated bone turnover markers, and bone loss. LVMI, the prevalence of left ventricular hypertrophy (LVH), and the prevalence of LVDD decreased, while LVEF increased. LVH was positively associated with postoperative intact parathyroid hormone (iPTH) and iPTH nonnormalization. ΔLVMI was positively associated with preoperative type-I collagen N-terminal peptide and postoperative iPTH. LVEF was negatively associated with postoperative phosphorous. ΔLVEF was negatively associated with postoperative iPTH. LVDD was positively associated with postoperative lumbar spine osteoporosis. Preoperative LVMI was negatively associated with ΔLVMI and positively associated with ΔLVEF. Advanced age, increased BMI, diabetes, longer dialysis time, lower albumin level, and higher total cholesterol and low-density lipoprotein levels were associated with LV remodeling.

Conclusions

LV remodeling partially improved after KT, showing a close relationship with MBD.

Keywords:

• Kidney transplantation
• mineral and bone disorder
• left ventricular remodeling
• left ventricular hypertrophy

Acknowledgment

We acknowledged that patients in this study were derived from our previous prospective cohort study(Sun, L., Wang, Z., Zheng, M., Hang, Z., Liu, J., Gao, X., Gui, Z., Feng, D., Zhang, D., Han, Q., Fei, S., Chen, H., Tao, J., Han, Z., Ju, X., Gu, M., & Tan, R. (2023). Mineral and bone disorder after kidney transplantation: a single-center cohort study. Renal Failure, 45(1), 2210231).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Reasonable requests for data will be accommodated by contacting the corresponding author.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant numbers 82270790, 82170769, 82070769, 81900684, 81870512], the ‘333 High Level Talents Project’ in Jiangsu Province [grant numbers BRA2015469, BRA2016514], Jiangsu Province Natural Science Foundation Program [grant number BK20191063] and Jiangsu Province Capability Improvement Project through Science, Technology and Education [grant number ZDXK202219].