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De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications.
Am J Kidney Dis. 2005 Oct; 46(4):720-33.AJ

Abstract

BACKGROUND

We aim to describe the risk, predictors, and outcomes associated with de novo congestive heart failure (CHF) after kidney transplantation.

METHODS

We used registry data from the US Renal Data System to retrospectively investigate de novo CHF in adult Medicare-insured transplant recipients and wait-listed candidates in 1995 to 2001. Heart failure was ascertained from inpatient and outpatient billing records, and participants were followed up until loss of Medicare or December 31, 2001. We used extended Cox hazards analysis to identify independent correlates of posttransplantation de novo CHF (adjusted hazard ratio [AHR], 95% confidence interval [CI]) and examine de novo CHF as a predictor of death and graft loss after transplantation.

RESULTS

In 27,011 transplant recipients, cumulative incidences of de novo CHF were 10.2% (95% CI, 9.8 to 10.6) and 18.3% (95% CI, 17.8 to 18.9) at 12 and 36 months and decreased to less than the demographic-adjusted incidence on the waiting list beyond the early posttransplantation period. Risk factors for de novo CHF included older recipient age, female sex, unemployed status at transplantation, pretransplantation comorbidities (anemia, diabetes mellitus, myocardial infarction, angina, cardiac arrhythmia, and peripheral vascular disease), transplant from older donors, donor cardiovascular death, and delayed graft function. We identified pretransplantation obesity, smoking, and posttransplantation complications, including hypertension, anemia, new-onset diabetes, myocardial infarction, and graft failure, as potentially modifiable correlates of de novo CHF. In separate analyses, de novo CHF predicted death (AHR, 2.6; 95% CI, 2.4 to 2.9) and death-censored graft failure (AHR, 2.7; 95% CI, 2.4 to 3.0).

CONCLUSION

Although associations may not reflect causality, identification of potentially mutable de novo CHF risk factors suggests targets for improving outcomes that should be evaluated prospectively.

Authors+Show Affiliations

Center for Outcomes Research, Division of Nephrology, Saint Louis University School of Medicine, St Louis, MO, USA. lentine.krista@stanfordalumni.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16183428

Citation

Lentine, Krista L., et al. "De Novo Congestive Heart Failure After Kidney Transplantation: a Common Condition With Poor Prognostic Implications." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 46, no. 4, 2005, pp. 720-33.
Lentine KL, Schnitzler MA, Abbott KC, et al. De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. Am J Kidney Dis. 2005;46(4):720-33.
Lentine, K. L., Schnitzler, M. A., Abbott, K. C., Li, L., Burroughs, T. E., Irish, W., & Brennan, D. C. (2005). De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 46(4), 720-33.
Lentine KL, et al. De Novo Congestive Heart Failure After Kidney Transplantation: a Common Condition With Poor Prognostic Implications. Am J Kidney Dis. 2005;46(4):720-33. PubMed PMID: 16183428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. AU - Lentine,Krista L, AU - Schnitzler,Mark A, AU - Abbott,Kevin C, AU - Li,Leiming, AU - Burroughs,Thomas E, AU - Irish,William, AU - Brennan,Daniel C, PY - 2005/04/26/received PY - 2005/06/27/accepted PY - 2005/9/27/pubmed PY - 2005/11/4/medline PY - 2005/9/27/entrez SP - 720 EP - 33 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 46 IS - 4 N2 - BACKGROUND: We aim to describe the risk, predictors, and outcomes associated with de novo congestive heart failure (CHF) after kidney transplantation. METHODS: We used registry data from the US Renal Data System to retrospectively investigate de novo CHF in adult Medicare-insured transplant recipients and wait-listed candidates in 1995 to 2001. Heart failure was ascertained from inpatient and outpatient billing records, and participants were followed up until loss of Medicare or December 31, 2001. We used extended Cox hazards analysis to identify independent correlates of posttransplantation de novo CHF (adjusted hazard ratio [AHR], 95% confidence interval [CI]) and examine de novo CHF as a predictor of death and graft loss after transplantation. RESULTS: In 27,011 transplant recipients, cumulative incidences of de novo CHF were 10.2% (95% CI, 9.8 to 10.6) and 18.3% (95% CI, 17.8 to 18.9) at 12 and 36 months and decreased to less than the demographic-adjusted incidence on the waiting list beyond the early posttransplantation period. Risk factors for de novo CHF included older recipient age, female sex, unemployed status at transplantation, pretransplantation comorbidities (anemia, diabetes mellitus, myocardial infarction, angina, cardiac arrhythmia, and peripheral vascular disease), transplant from older donors, donor cardiovascular death, and delayed graft function. We identified pretransplantation obesity, smoking, and posttransplantation complications, including hypertension, anemia, new-onset diabetes, myocardial infarction, and graft failure, as potentially modifiable correlates of de novo CHF. In separate analyses, de novo CHF predicted death (AHR, 2.6; 95% CI, 2.4 to 2.9) and death-censored graft failure (AHR, 2.7; 95% CI, 2.4 to 3.0). CONCLUSION: Although associations may not reflect causality, identification of potentially mutable de novo CHF risk factors suggests targets for improving outcomes that should be evaluated prospectively. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16183428/De_novo_congestive_heart_failure_after_kidney_transplantation:_a_common_condition_with_poor_prognostic_implications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)00916-9 DB - PRIME DP - Unbound Medicine ER -