Association of post transplantation anaemia and persistent secondary hyperparathyroidism with diastolic function in stable kidney transplant recipients

Abstract

Introduction: We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients. Methods: We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardio-graphy in 43 kidney transplant recipients with a transplant duration of ≥6 months, no acute rejection and a glomerular filtration rate of ≥15 mL/min/1.73m2 . Results: Mean (SD; range) transplant duration was 12.3 (8.0; 0.5–33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established con-founder adjusted analysis, haemoglobin (partial R=−0.394, p=0.01) and parathyroid hormone concentrations (partial R=0.382, p=0.02) were associated with E/e’. In multivariable analysis, haemoglobin (partial R=−0.278, p=0.01) and parathyroid levels (partial R=0.324, p=0.04) were independently associated with E/e’. Waist–height ratio (partial R=−0.526, p=0.001 and partial R= −0.355, p=0.03), waist circumference (partial R=−0.433, p=0.008 and partial R=−0.393, p=0.02) and body mass index (partial R=−0.332, p=0.04 and partial R=−0.489, p=0.002) were associated with both e’ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/e’ (partial R=−0.422, p=0.02), parathyroid hormone-E/e’ (partial R=0.434, p=0.03), waist–height ratio-e’ (partial R=−0.497, p=0.007) and body mass index-E/A (partial R=−0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures. Conclusion: Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyper-parathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.