title: Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom.
abstract: BACKGROUND
  We investigated the incidence of chronic kidney disease (CKD) in the United Kingdom heart transplant population, identified risk factors for the development of CKD, and assessed the impact of CKD on subsequent survival.
  
  
  METHODS
  Data from the UK Cardiothoracic Transplant Audit and UK Renal Registry were linked for 1732 adult heart transplantations, 1996 to 2007. Factors influencing time to CKD, defined as National Kidney Foundation CKD stage 4 or 5 or preemptive kidney transplantation, were identified using a Cox proportional hazards model. The effects of distinct CKD stages on survival were evaluated using time-dependent covariates.
  
  
  RESULTS
  A total of 3% of patients had CKD at transplantation, 11% at 1-year and more than 15% at 6 years posttransplantation and beyond. Earlier transplantations, shorter ischemia times, female, older, hepatitis C virus positive, and diabetic recipients were at increased risk of developing CKD, along with those with impaired renal function pretransplantation or early posttransplantation. Significant differences between transplantation centers were also observed. The risk of death was significantly higher for patients at CKD stage 4, stage 5 (excluding dialysis), or on dialysis, compared with equivalent patients surviving to the same time point with CKD stage 3 or lower (hazard ratios of 1.66, 8.54, and 4.07, respectively).
  
  
  CONCLUSIONS
  CKD is a common complication of heart transplantation in the UK, and several risk factors identified in other studies are also relevant in this population. By linking national heart transplantation and renal data, we have determined the impact of CKD stage and dialysis treatment on subsequent survival in heart transplant recipients.
authors.affiliation: UK Cardiothoracic Transplant Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Thomas
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Cara L
authors.initials: CL
authors.lastname: Murphy
authors.forename: Retha
authors.initials: R
authors.lastname: Steenkamp
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Birch
authors.forename: Damian G
authors.initials: DG
authors.lastname: Fogarty
authors.forename: And Robert S
authors.initials: AR
authors.lastname: Bonser
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology