Silent cardiac burden: Echocardiographic abnormalities and their predictors in kidney transplant candidates and their impact on graft function

Table 1 General characteristics

Variables	n	Percentage (%)/mean ± SD
Age
18-50 years	149	58
> 50 years	110	42
Gender
Male	158	61
Female	101	39
BMI at time of transplant
< 25	123	47
25-30	76	29
> 30	60	23
Hypertension	252	97
Dyslipidemia	97	37
Smoking	121	47
Hyperuricemia	78	30
Impaired fasting glucose	131	51
Family history of coronary artery disease	20	8
Obesity	90	35
Renal replacement therapies
Preemptive transplant	14	5
Hemodialysis	208	81
Peritoneal dialysis	36	14
PH	66	25.5
DD	71	28
LVSD	31	12
Duration of dialysis in months	242	22.65 ± 21.90
Total cholesterol (mmol/L)	258	4.41 ± 1.16
LDL-cholesterol (mmol/L)	258	2.69 ± 2.02
HDL-cholesterol (mmol/L)	258	1.29 ± 0.49
Triglyceride (mmol/L)	258	1.61 ± 1.14
eGFR at discharge (mL/minute)	258	89.83 ± 30.69
eGFR at 6 months (mL/minute)	252	89.58 ± 28.99
eGFR at 1 year (mL/minute)	216	91.00 ± 26.92
eGFR at 2 years (mL/minute)	122	90.26 ± 26.76

BMI: Body mass index; DD: Diastolic dysfunction; eGFR: Estimated glomerular filtration rate; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LVSD: Left ventricular systolic dysfunction; PH: Pulmonary hypertension.

Table 2 Echocardiographic findings

Variables	n	Percentage (%)
LVH	92	36
LVSD
Ejection fraction 50% or more	226	87.9
Mild dysfunction LVSD 40%-49%	23	8.9
Moderate dysfunction LVSD 30%-39%	7	2.7
LVSD less than 30%	1	0.4
DD
Impaired relaxation	60	85
Pseudonormal filling	10	14
Restrictive filling	1	1
PH in mmHg
Mild 20-40 mmHg	52	72.8
Moderate 41-55 mmHg	12	18.2
Severe > 55 mmHg	2	3
MR (grades)
Mild	126	56
Mild to moderate	94	22
Moderate to severe	4	2
Mitral stenosis
Yes	1	1
No	256	99
TR (grades)
Mild	150	90
Moderate	15	9
Severe	1	1
AR (grades)
Mild	43	96
Moderate	2	4
Aortic stenosis (grades)
Mild	3	100
Moderate	0	0
Severe	0	0
Pericardial effusion (grades)
Mild, less than 1 mm	38	88
Moderate 1-2 mm	5	12
Large, more than 2 mm	0	0

AR: Aortic regurgitation; DD: Diastolic dysfunction; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; MR: Mitral regurgitation; PH: Pulmonary hypertension; TR: Tricuspid regurgitation.

Table 3 Predictors of left ventricular hypertrophy, n (%)/mean ± SD

Variables	Univariate analysis			Multivariate analysis
	LVH	No LVH	P value	OR (95%CI)	P value
Age			0.28
18-50 years	49 (33)	100 (67)
> 50 years	43 (39)	66 (61)
Gender			0.004	2.51 (1.17-5.41)	0.02
Male	76 (42)	91 (58)
Female	25 (25)	75 (75)
Obesity	29 (33)	60 (67)	0.49
BMI ranges			0.78
< 25	46 (38)	76 (62)
25-30	25 (33)	51 (67)
> 30	21 (35)	39 (65)
PH	34 (52)	58 (30)	0.002	2.07 (1.11-3.86)	0.02
Mitral regurgitation (grade 2-4)	49 (39)	33 (35)	0.56
Tricuspid regurgitation	33 (37)	59 (36)	0.89
Aortic regurgitation	18 (40)	74 (35)	0.61
LVSD	17 (55)	14 (45)	0.016	2.11 (0.89-5.02)	0.09
DD	38 (54)	33 (46)	< 0.001	2.47 (1.29-4.73)	0.006
MR (grade 2-3)	49 (39)	77 (61)	0.58
TR	59 (36)	107 (64)	0.89
AR	18 (40)	27 (60)	0.61
Hypertension	91 (36)	160 (64)	0.43
Pericardial effusion	18 (44)	33 (56)	0.24
Dyslipidemia	46 (48)	50 (52)	0.002	1.94 (1.07-3.53)	0.03
Smoking	49 (40)	72 (60)	0.13	0.46 (0.36-1.58)	0.46
Diabetes	15 (44)	19 (56)	0.27
Impaired fasting glucose	55 (42)	75 (58)	0.03	1.38 (0.76-2.50)	0.30
Hyperuricemia	27 (35)	50 (65)	0.90
Duration of dialysis in months	22.23 ± 19.71	23.00 ± 23.15	0.79
Total-cholesterol (mmol/L)	4.49 ± 1.27	4.36 ± 1.09	0.40
LDL cholesterol (mmol/L)	2.93 ± 3.16	2.55 ± 0.90	0.26
HDL cholesterol (mmol/L)	1.25 ± 0.50	1.23 ± 0.49	0.74
Triglyceride (mmol/L)	1.72 ± 1.17	1.54 ± 1.12	0.23
Phosphate (mmol/L)	1.54 ± 0.56	1.53 ± 0.57	0.88
PTH (pmol/L)	22.68 ± 25.95	29.52 ± 27.12	0.17	1.00 (0.98-1.02)	0.79
Family history of coronary artery disease	4 (20)	16 (80)	0.13	0.37 (0.11-1.30)	0.12
Pre-emptive transplant	6 (43)	8 (57)	0.82
Hemodialysis	74 (36)	133 (64)
Peritoneal dialysis	12 (33)	24 (67)

AR: Aortic regurgitation; DD: Diastolic dysfunction; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; MR: Mitral regurgitation; PH: Pulmonary hypertension; TR: Tricuspid regurgitation.

Table 4 Predictors of left ventricular systolic dysfunction, n (%)/mean ± SD

Variables	Univariate analysis			Multivariate analysis
	LVSD	No LVSD	P value	OR (95%CI)	P value
Age			0.71
18-50 years	17 (11)	132 (89)
> 50 years	14 (13)	94 (87)
Gender			0.42
Male	21 (13)	136 (87)
Female	10 (10)	90 (90)
Obesity	13 (15)	76 (85)	0.37
BMI ranges			0.58
< 25	15 (12)	106 (88)
25-30	7 (9)	69 (91)
> 30	9 (15)	51 (85)
PH	9 (14)	57 (86)	0.65
DD	18 (26)	52 (74)	< 0.001	3.33 (1.41-7.81)	0.006
LVH	17 (19)	74 (81)	0.016	2.33 (0.97-5.60)	0.058
MR (Grade 2-3)	22 (18)	104 (82)	0.04	2.38 (0.93-6.12)	0.07
TR	23 (14)	142 (86)	0.32
AR	7 (16)	38 (84)	0.20
Hypertension	31 (12)	219 (88)	> 0.999
Pericardial effusion	9 (22)	32(78)	0.06	1.78 (0.67-4.77)	0.25
Dyslipidemia	26 (27)	70 (73)	0.90
Smoking	18 (15)	102 (85)	0.18	1.55 (0.64-3.76)	0.33
Diabetes	5 (15)	29 (85)	0.58
Impaired fasting glucose	15 (12)	114 (88)	0.83
Hyperuricemia	12 (16)	65 (84)	0.26
Duration of dialysis in months	18.62 ± 8.67	23.22 ± 23.15	0.045	0.98 (0.96-1.01)	0.24
Total cholesterol (mmol/L)	4.30 ± 1.11	4.41 ± 1.16	0.63
LDL-cholesterol (mmol/L)	3.34 ± 5.20	2.59 ± 0.99	0.43
HDL-cholesterol (mmol/L)	1.25 ± 0.59	1.23 ± 0.48	0.81
Triglycerides (mmol/L)	1.83 ± 1.36	1.58 ± 1.11	0.24
Mean phosphate (mmol/L)	1.60 ± 0.48	1.52 ± 0.58	0.54
Mean PTH (pmol/L)	22.81 ± 24.26	27.2 ± 27.26	0.49
Family history of coronary artery disease	6 (30)	14 (70)	0.02	4.50 (1.33-15.20)	0.015
Pre-emptive transplant	1 (7)	13 (93)	0.87	0.98 (0.96-1.01)	0.24
Hemodialysis	25(12)	181 (88)
Peritoneal dialysis	5 (14)	31 (86)

AR: Aortic regurgitation; BMI: Body mass index; DD: Diastolic dysfunction; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; MR: Mitral regurgitation; OR: Odds ratio; PTH: Parathyroid hormone; PH: Pulmonary hypertension; TR: Tricuspid regurgitation.

Table 5 Predictors of diastolic dysfunction, n (%)/mean ± SD

Variables	Univariate analysis			Multivariate analysis
	DD	No DD	P value	OR (95%CI)	P value
Age			< 0.001	1.51 (0.49-4.60)	0.48
18-50 years	25 (17)	124 (83)
> 50 years	46 (42)	63 (58)
Gender
Male	46 (29)	112 (71)	0.47
Female	25 (25)	75 (75)
Obesity	27 (30)	62 (70)	0.48
BMI ranges			0.45
< 25	31 (25)	91 (75)
25-30	25 (33)	51 (77)
> 30	15 (25)	45 (75)
PH	21 (32)	45 (68)	0.37
LVSD	18 (58)	13 (42)	< 0.001	3.50 (0.98-12.51)	0.054
LVH	38 (41)	54 (59)	< 0.001	1.76 (0.70-4.41)	0.23
MR (grade 2-3)	44 (35)	82 (65)	0.37	1.84 (0.73-4.65)	0.20
TR	51 (31)	115 (69)	0.19	1.94 (0.69-5.50)	0.21
AR	16 (36)	29 (64)	0.20	1.26 (0.43-3.70)	0.67
Hypertension	71 (28)	180 (72)	0.20
Pericardial effusion	19 (46)	22 (54)	0.003	1.58 (0.50-4.98)	0.44
Dyslipidemia	26 (27)	70 (73)	0.90
Smoking	39 (32)	82 (68)	0.11	0.98 (0.39-2.48)	0.96
Diabetes	11 (32)	23 (68)	0.50
Impaired fasting glucose	50 (38)	80 (62)	< 0.001	1.74 (0.56-5.42)	0.34
Hyperuricemia	23 (30)	54 (70)	0.58
Duration of dialysis in months	24.96 ± 25.04	21.82 ± 20.55	0.32
Total cholesterol (mmol/L)	4.37 ± 1.13	4.42 ± 1.17	0.78
LDL-cholesterol (mmol/L)	2.88 ± 3.50	2.61 ± 1.01	0.34
HDL-cholesterol (mmol/L)	1.27 ± 0.55	1.22 ± 0.47	0.53
Triglyceride (mmol/L)	1.64 ± 1.22	1.59 ± 1.11	0.76
Mean phosphate level (mmol/L)	1.57 ± 0.57	1.50 ± 0.57	0.50
Family history of coronary artery disease	8 (40)	12 (60)	0.20	0.71 (0.16-3.14)	0.65
Mean PTH level (pmol/L)	21.46 ± 21.77	30.49 ± 29.65	0.06	0.11 (0.98-0.96)	1.00
Pre-emptive transplant	1 (7)	13 (93)	0.17	10.03 (1.71-58.94)	0.001
Hemodialysis	58 (28)	149 (72)
Peritoneal dialysis	12 (33)	24 (67)

AR: Aortic regurgitation; BMI: Body mass index; DD: Diastolic dysfunction; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; MR: Mitral regurgitation; OR: Odds ratio; PTH: Parathyroid hormone; PH: Pulmonary hypertension; TR: Tricuspid regurgitation.

Table 6 Predictors of pulmonary hypertension, n (%)/mean ± SD

Variables	Univariate analysis			Multivariate analysis
	PH	No PH	P value	OR (95%CI)	P value
Age			0.23
18-50 years	34 (23)	115 (77)
> 50 years	32 (29)	77 (71)
Gender
Male	44 (28)	114 (72)	0.29
Female	22 (22)	78 (78)
Obesity	12 (13)	88 (87)	0.001	0.29 (0.05-1.69)	0.17
BMI ranges			0.03
< 25	40 (33)	82 (67)
25-30	17 (22)	59 (78)		0.79 (0.22-2.79)	0.71
> 30	9 (15)	51 (75)		0.85 (0.10- 7.55)	0.88
DD	21 (30)	50 (70)	0.37
LVSD	9 (29)	22 (71)	0.65
LVH	34 (37)	58 (63)	0.02	3.3 (1.05-10.55)	0.04
MR (grade 2-3)	45 (36)	81 (64)	< 0.001	4.6 (1.45-14.78)	0.01
TR	51 (31)	115 (69)	0.01	3.70 (0.93-14.69)	0.06
AR	18 (40)	27 (60)	0.02	0.57 (0.16-2.00)	0.38
Hypertension	64 (25)	187 (75)	0.99
Pericardial effusion	17 (41)	224 (59)	0.012	2.28 (0.63-8.31)	0.21
Dyslipidemia	31(32)	65 (68)	0.057	2.80 (0.80-9.81)	0.11
Smoking	29 (24)	92 (76)	0.58
Diabetes	4 (12)	30 (88)	0.048	0.79 (0.16-9.32)	0.77
Impaired fasting glucose	32 (25)	98 (75)	0.72
Hyperuricemia	20 (26)	57 (74)	0.93
Duration of renal replacement therapy	20.29 ± 21.66	23.61 ± 22.01	0.30
Total cholesterol (mmol/L)	4.27 ± 1.11	4.45 ± 1.17	0.28
LDL-cholesterol (mmol/L)	2.45 ± 0.93	2.77 ± 2.28	0.28
HDL-cholesterol (mmol/L)	1.35 ± 0.61	1.20 ± 0.44	0.08
Triglyceride (mmol/L)	1.46±0.95	1.66 ± 1.20	0.22
Mean phosphate level (mmol/L)	1.40 ± 0.46	1.59 ± 0.60	0.11	0.42 (0.18-1.08)	0.07
Family history of coronary artery disease	2 (10)	18 (90)	0.10	0.55 (0.08-3.64)	0.54
Pre-emptive transplant	1 (7)	13 (93)	0.26
Hemodialysis	55 (27)	152 (73)
Peritoneal dialysis	10(28)	26 (72)

AR: Aortic regurgitation; BMI: Body mass index; CI: Confidence interval; DD: Diastolic dysfunction; HD: Hemodialysis; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; MR: Mitral regurgitation; OR: Odds ratio; PH: Pulmonary hypertension; PD: Peritoneal dialysis; TR: Tricuspid regurgitation.

Table 7 Impact of left ventricular hypertrophy, left ventricular systolic dysfunction, diastolic dysfunction, and pulmonary hypertension on estimated glomerular filtration rates, mean ± SD

Graft function	Echocardiographic findings				P value
eGFR	Number	mean ± SD	Number	mean ± SD
	LVH		No LVH
eGFR at discharge (mL/minute)	91	86.63 ± 30.37	164	91.40 ± 30.80	0.23
eGFR at 6 months (mL/minute)	90	86.40 ± 28.69	161	91.17 ± 29.10	0.21
eGFR at 1 year (mL/minute)	79	89.62 ± 25.62	136	91.60 ± 27.69	0.60
eGFR at 2 years (mL/minute)	51	86.73 ± 28.21	70	92.36 ± 25.47	0.25
	LVSD		No LVSD
eGFR at discharge (mL/minute)	31	83.97 ± 30.98	223	90.68 ± 30.55
eGFR at 6 months (mL/minute)	31	84.84 ± 30.78	219	90.26 ± 28.72
eGFR at 1 year (mL/minute)	23	92.26 ± 22.72	191	90.81 ± 27.45
eGFR at 2 years (mL/minute)	16	95.25 ± 24.92	105	89.18 ± 26.97
	DD		No DD
eGFR at discharge (mL/minute)	70	86.73 ± 32.56	185	90.82 ± 29.95	0.34
eGFR at 6 months (mL/minute)	70	87.56 ± 27.66	181	90.19 ± 29.53	0.52
eGFR at 1 year (mL/minute)	59	91.97 ± 26.45	156	90.46 ± 27.15	0.71
eGFR at 2 years (mL/minute)	34	93.03 ± 25.67	87	88.79 ± 27.13	0.43
	PH		No PH
eGFR at discharge (mL/minute)	66	90.97 ± 30.18	189	89.25 ± 30.91	0.70
eGFR at 6 months (mL/minute)	65	89.15 ± 26.46	186	89.56 ± 29.89	0.92
eGFR at 1 year (mL/minute)	63	91.05 ± 26.71	152	90.80 ± 27.07	0.95
eGFR at 2 years (mL/minute)	52	91.19 ± 26.72	69	89.07 ± 26.82	0.67

DD: Diastolic dysfunction; eGFR: Estimated glomerular filtration rate; LVH: Left ventricular hypertrophy; LVSD: Left ventricular systolic dysfunction; PH: Pulmonary hypertension.