From: Reuters
Published May 20, 2008 11:36 AM

Heart condition in those awaiting a kidney an ominous sign

NEW YORK (Reuters Health) - The presence of an often silent heart condition -- systolic dysfunction, or decreased pumping action of the heart -- nearly doubles the risk of death for patients on kidney transplant waiting lists, according to a study appearing in the Journal of the American Society of Nephrology for June.

"This study identifies a subset of chronic kidney disease population at significantly higher risk for death while awaiting transplantation, where the role of medical interventions and devices such as implantable cardiac defibrillators and pacemakers should be studied," Dr. Angelo M. de Mattos, from the University of California in Sacramento, and colleagues write.

Widely available tests could be used to help identify those patients with chronic kidney disease who have systolic dysfunction, they add.

The link between overt heart failure and death in patients with end-stage renal disease is well documented. The extent to which lesser degrees of cardiac dysfunction reduce survival, however, is unclear.

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In the current study, researchers analyzed the records of 2,718 kidney transplant candidates seen at one center. Overall, 681 patients died during a median follow-up period of 27 months.

The research team discovered that patients with systolic dysfunction were nearly twice as likely to die as those without this condition.

The median survival period for patients with systolic dysfunction was 49 months, significantly shorter than the 72 months seen in patients without dysfunction, but on par with the 48 months noted in patients with cardiac ischemia (restricted blood flow) -- the most well-known risk factor for heart-related death in patients with chronic kidney disease.

If these findings are confirmed in additional studies, de Mattos and colleagues say organ distribution policies may need to be revamped so as to place a priority on people with systolic dysfunction who traditionally have not been considered at an increased risk of death.

SOURCE: Journal of the American Society of Nephrology, June 2008.

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