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

Figures & data

Table 1. Basic clinical data of enrolled KTRs (n = 95).

Index	Level	n = 95
Age(years)		40.2 ± 10.8
Sex, %(N)	Male	71.6(68)
	Female	28.4(27)
Menstrual status, %(N)	Premenopausal	24.2(23)
	Menopausal	4.2(4)
Time of RRT(months)		27(14,48)
Dialysis mode, %(N)
	Hemodialysis	70.5 (67)
	Peritoneal dialysis	29.5 (28)
Primary kidney disease, %(N)
	Glomerulonephritis	93.7(89)
	Anaphylactic purpura nephritis	3.2(3)
	Polycystic kidney	2.1(2)
	Interstitial nephritis	1.1(1)
Smoking, %(N)		7.4(7)
Alcohol taking, %(N)		5.3(5)
TPTX + AT, %(N)		4.2(4)
Pre-parathyroid hyperplasia/nodule, %(N)		23.1(22)
Post-parathyroid hyperplasia/nodule, %(N)		28.4(27)
Post-erythropoietin, %(N)		6.3(6)
Post-statins, %(N)		9.5(9)
Post-calcium use, %(N)		6.3(6)
Post-calcitriol use, %(N)		20.0(19)
Post-eGFR (mL/min *1.73 m^2)		74.7 ± 21.3
CKD stage one year post-KT, %(N)
	CKD 1 T	25.3(24)
	CKD 2 T	49.5(47)
	CKD 3 T	25.3(24)
	CKD 4 T	0(0)
	CKD 5 T	0(0)

Abbreviations: KTRs: kidney transplant recipients; RRT: Renal replacement therapy; TPTX + AT: total parathyroidectomy with forearm autotransplantation; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; KT: kidney transplantation.

Table 2. Change of relevant clinical and laboratory index after KT.

Index	Pre-transplantation	Post-transplantation	p-value
BMI (kg/m^2)	21.2 ± 3.3	21.7 ± 4.0	0.877
Hypertension, %(N)	82.1(78)	57.9(55)	<0.001
Diabetes, %(N)	9.5(9)	12.6(12)	0.180
CCB, %(N)	62.1(59)	42.1(40)	0.001
ACEI/ARB, %(N)	30.5(29)	11.6(11)	<0.001
SBP(mmHg)	144.4 ± 17.6	128.6 ± 15.0	<0.001
DBP(mmHg)	92.1 ± 14.6	80.9 ± 10.9	<0.001
Hemoglobin(g/L)	112.60 ± 20.05	135.12 ± 21.45	<0.001
Albumin(ng/ml)	41.94 ± 5.5	40.82 ± 3.18	0.066
Uric Acid(μmmol/L)	378.35 ± 118.32	348.79 ± 78.78	0.048
TC(mmol/L)	4.47 ± 1.17	4.65 ± 0.98	0.245
TG(mmol/L)	1.89 ± 1.47	1.42 ± 0.76	0.002
HDL(mmol/L)	1.08 ± 0.54	1.26 ± 0.28	0.001
LDL(mmol/L)	2.89 ± 0.74	2.80 ± 0.64	0.334

Abbreviations: KT, Kidney transplantation; BMI, body mass index; CCB, calcium channel blockers; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Figure 1. Prevalence of osteopenia and osteoporosis (%) at various skeletal sites (FN, femoral neck; LS, lumbar spine).

Table 3. Changes of metabolism biochemical markers and BMD after KT (n = 95).

Index	Pre-transplantation	Post-transplantation	P-value
Ca(mmol/L)	2.33 ± 0.23	2.37 ± 0.15	0.136
P(mmol/L)	1.85 ± 0.55	0.93 ± 0.18	<0.001
iPTH (pg/mL)	347.21 ± 306.22	100.66 ± 70.33	<0.001
25(OH)vitD(nmol/L)	47.38 ± 29.06	45.70 ± 18.02	0.527
OC(ng/mL)	180.83 ± 100.27	25.74 ± 20.69	<0.001
BALP(U/L)	17.67 ± 13.54	19.09 ± 14.60	0.342
NTx(ng/ml)	319.12 ± 301.32	76.25 ± 79.14	<0.001
CTx(ng/ml)	2.21 ± 1.40	0.76 ± 0.52	<0.001
FN BMD (g/cm^2)	0.75 ± 0.13	0.69 ± 0.09	0.001
LS BMD (g/cm^2)	0.97 ± 0.11	0.87 ± 0.28	0.021

Abbreviations: BMD: bone mineral density; LV: left ventricular; KT: kidney transplantation; Ca: calcium; P: phosphorus; iPTH: intact parathyroid hormone; 25(OH)vitD: 25-hydroxyvitamin D; OC: osteocalcin; BALP: bone specific alkaline phosphatase; NTx: Type I collagen cross-linked N-terminal peptide; CTx: Type I collagen cross-linked C-terminal peptide; FN BMD: femoral neck bone mineral density; LS BMD: lumbar spine bone mineral density.

Table 4. Changes of LV index after KT (n = 95).

Index	Pre-transplantation	Post-transplantation	p-value
LVMI(g/m^2.7)	60.00 ± 19.43	51.42 ± 13.23	0.001
LVH, %(N)	57.9(55)	42.1(40)	0.004
LVEF(%)	62.06 ± 5.34	64.06 ± 2.42	0.005
LVDD, %(N)	21.4(20)	9.5(9)	0.038
Aod(mm)	29.20 ± 3.20	29.56 ± 3.12	0.334
LAD(mm)	35.40 ± 5.67	34.00 ± 4.65	0.025
LVDd(mm)	49.09 ± 5.98	46.43 ± 3.90	<0.001
LVDs(mm)	32.84 ± 4.83	30.25 ± 2.59	<0.001
IVS(mm)	11.38 ± 2.75	10.85 ± 1.30	0.079
LVPW(mm)	10.85 ± 1.68	10.48 ± 1.21	0.039
FS(%)	33.56 ± 3.91	34.85 ± 1.82	0.014
E1(cm/s)	75.32 ± 20.18	66.60 ± 15.73	0.001
A1(cm/s)	80.54 ± 17.53	75.52 ± 18.29	0.033
septal motion E’(cm/s)	7.05 ± 2.28	7.80 ± 5.04	0.234
mitral ring lateral wall E’(cm/s)	9.91 ± 0.29	0.93 ± 0.31	0.104
E/A	0.97 ± 0.29	0.93 ± 0.31	0.252
E/e’	9.53 ± 2.98	9.77 ± 2.18	0.867

Abbreviations: LVMI: left ventricular mass index; LVH: left ventricular hypertrophy; LVEF: left ventricular ejection fraction; LVDD: left ventricular diastolic dysfunction; Aod: ascending aorta diameter; LAD: left atrial diameter; LVDd: left ventricular end-diastolic diameter; LVDs: left ventricular end-systolic diameter; IVS: interventricular septal thickness; LVPW: posterior left ventricular wall thickness; LVEF: left ventricular ejection fraction; E1, A1: mitral valve diastolic flow velocity; E ‘: mitral ring lateral wall and septal motion velocity.

Table 5. Results of logistic regression analysis of influencing factors of postoperative LVH (n = 95).

Factors	Univariate analysis			Multivariate analysis
	OR	95%CI	p-value	OR	95%CI	p-value
Age(years)	1.067	1.021 ∼ 1.115	0.004
pre-BMI (kg/m^2)	1.370	1.135 ∼ 1.653	0.001	1.268	1.023 ∼ 1.570	0.030
post- iPTH (pg/mL)	1.007	1.000 ∼ 1.015	0.048
iPTH unnormalization	5.633	2.073 ∼ 15.311	0.001	5.030	1.099 ∼ 23.014	0.037

Abbreviations: LVH: left ventricular hypertrophy; BMI: body mass index; P: phosphorus; iPTH: intact parathyroid hormone.

Annotation: All demographic and biochemical variables have been tested, including factors related to hypertension, diabetes, hyperlipidemia, hyperuricemia, hemoglobin, albumin, bone metabolism index and appropriate medication informations, and only significant factors were included in the table.

Table 6. Results of linear regression analysis of influencing factors of ΔLVMI (n = 95).

Factors	Univariate analysis			Multivariate analysis
	Regression coefficient	95%CI	p-value	Regression coefficient	95%CI	p-value
Time of RRT(months)	0.226	0.065 ∼ 0.386	0.007
pre-NTx(ng/ml)	0.017	0.003 ∼ 0.031	0.018
pre-LVMI(g/m^2.7)	−0.778	−0.922∼-0.634	<0.001	−0.697	−0.814∼-0.579	<0.001
post-BMI (kg/m^2)	1.55	0.535 ∼ 2.564	0.003
post- iPTH (pg/mL)	18.581	1.082 ∼ 36.08	0.038	15.034	4.498 ∼ 25.569	0.006

Abbreviations: ΔLVMI: change of left ventricular mass index; RRT: Renal replacement therapy; Mg: magnesium; NTx: Type I collagen cross-linked N-terminal peptide; LVMI: left ventricular mass index; BMI: body mass index; iPTH, intact parathyroid hormone.

Annotation: All demographic and biochemical variables have been tested, including factors related to hypertension, diabetes, hyperlipidemia, hyperuricemia, hemoglobin, albumin, bone metabolism index and appropriate medication informations, and only significant factors were included in the table.

Table 7. Results of linear regression analysis of influencing factors of postoperative LVEF (n = 95).

Factors	Univariate analysis			Multivariate analysis
	Regression coefficient	95%CI	p-value	Regression coefficient	95%CI	p-value
post- P(mmol/L)	−0.050	−0.087∼-0.012	0.011	−0.052	−0.090∼-0.013	0.009
ΔLVMI(g/m^2.7)	−0.00038	−0.00075∼-0.00003	0.037	−0.000425	−0.000768∼-0.000083	0.015

Abbreviations: LVEF: left ventricular ejection fraction; P: phosphorus; Δ LVMI: change of left ventricular mass index.

Annotation: All demographic and biochemical variables have been tested, including factors related to hypertension, diabetes, hyperlipidemia, hyperuricemia, hemoglobin, albumin, bone metabolism index and appropriate medication informations, and only significant factors were included in the table.

Table 8. Results of linear regression analysis of influencing factors of ΔLVEF (n = 95).

Factors	Univariate analysis			Multivariate analysis
	Regression coefficient	95%CI	p-value	Regression coefficient	95%CI	p-value
Age(years)	−0.241	−0.428∼−0.055	0.012
pre-BMI (kg/m^2)	−0.545	−1.069∼−0.022	0.041	−0.24	−0.422∼−0.025	0.011
pre-albumin(g/L)	0.48	0.105 ∼ 0.855	0.013
pre-LVEF(%)	−1.08	−1.18∼−0.98	<0.001	−1.152	−1.291∼−1.013	<0.001
pre-LVMI(g/m^2.7)	0.148	0.084 ∼ 0.212	<0.001
post-albumin(g/L)	1.059	0.419 ∼ 1.698	0.001
post-iPTH (pg/mL)	−0.036	−0.065∼−0.006	0.019

Abbreviations: ΔLVEF: change of left ventricular ejection fraction; BMI: body mass index; Alb: albumin; LVEF: left ventricular ejection fraction; LVMI: left ventricular mass index; iPTH: intact parathyroid hormone.

Annotation: All demographic and biochemical variables have been tested, including factors related to hypertension, diabetes, hyperlipidemia, hyperuricemia, hemoglobin, albumin, bone metabolism index and appropriate medication informations, and only significant factors were included in the table.

Table 9. Results of logistic regression analysis of influencing factors of postoperative LV diastolic dysfunction (n = 95).

Factors	Univariate analysis			Multivariate analysis
	OR	95%CI	p-value	OR	95%CI	p-value
Age(years)	1.130	1.037 ∼ 1.231	0.005	1.119	1.009 ∼ 1.241	0.033
pre-diabetes	7.700	1.471 ∼ 40.293	0.016
post-diabetes	8.571	1.863 ∼ 39.426	0.006
post-TC(mmol/L)	2.092	1.007 ∼ 4.346	0.048
post-LDL(mmol/L)	2.964	1.051 ∼ 8.358	0.040
pre-uric acid	0993	0.987 ∼ 0.999	0.028	0.989	0.979 ∼ 0.998	0.019
post-LS BMD
Osteopenia^a	2.120	0.399 ∼ 11.256	0.378	2.742	0.376 ∼ 19.994	0.320
Osteoporosis^a	17.667	1.809 ∼ 172.571	0.014	39.331	1.775 ∼ 871.569	0.020

Abbreviations: LV: left ventricular; TC: total cholesterol; LDL: low-density lipoprotein; LS BMD: lumbar spine bone mineral density.

^a Compared with the group with normal BMD level.

Annotation: All demographic and biochemical variables have been tested, including factors related to hypertension, diabetes, hyperlipidemia, hyperuricemia, hemoglobin, albumin, bone metabolism index and appropriate medication informations, and only significant factors were included in the table.

Data availability statement

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