De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications.
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).


CONCLUSIONS
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.
Lentine
Krista L
KL
Center for Outcomes Research, Division of Nephrology, Saint Louis University School of Medicine, St Louis, MO, USA. lentine.krista@stanfordalumni.org
Schnitzler
Mark A
MA
Abbott
Kevin C
KC
Li
Leiming
L
Burroughs
Thomas E
TE
Irish
William
W
Brennan
Daniel C
DC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
D007166:Immunosuppressive Agents