Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation.
Cardiovascular disease is the major cause of mortality in patients with end-stage renal disease (ESRD). This study examined the all-cause mortality in 3,698 patients with ESRD evaluated for kidney transplantation at our institution from 2001 to 2004. Mean age for the cohort was 48+/-12 years, and 42% were women. Stress myocardial perfusion imaging was done in 2,207 patients (60%) and coronary angiography in 260 patients (7%). There were 622 deaths (17%) during a mean follow-up period of 30+/-15 months. The presence and severity of coronary disease on angiography was not predictive of survival. Coronary revascularization did not impact survival (p=0.6) except in patients with 3-vessel disease (p=0.05). The best predictor of death was left ventricular ejection fraction, measured by gated myocardial perfusion imaging, with 2.7% mortality increase for each 1% ejection fraction decrease. In conclusion, left ventricular ejection fraction is a strong predictor of survival in patients with ESRD awaiting renal transplantation. Strategies to improve cardiac function or earlier renal transplantation deserve further studies.
Hage
Fadi G
FG
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Smalheiser
Stuart
S
Zoghbi
Gilbert J
GJ
Perry
Gilbert J
GJ
Deierhoi
Mark
M
Warnock
David
D
Iskandrian
Ami E
AE
de Mattos
Angelo M
AM
Aqel
Raed A
RA
D000328:Adult; D017023:Coronary Angiography; D003928:Diabetic Nephropathies / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016277:Ventricular Function, Left