3. Cardiovascular disease in patients with transplanted kidney

Thanks to the progress in histocompatibility testing and better immunosuppressive therapy, graft survival has increased, so that the leading cause of graft loss after transplantation has been the death of a patient with functional graft. Cardiovascular disease is the leading cause of death in patients with a transplanted kidney [38]. Despite the fact that patients with a transplanted kidney are highly susceptible to infections and have an increased tendency to develop malignant diseases, these patients die mainly of cardiovascular disease. Although kidney transplantation, in contrast to dialysis, reduces the risk of cardiovascular disease by restoring kidney function, it also brings new risk factors related to the status of transplantation and its treatment and risk factors related to the chronic decline in the function of the allograft. The increased incidence of cardiovascular diseases in patients with transplanted kidney is a consequence of the high prevalence of risk factors for the development of cardiovascular diseases in these patients. The incidence of cardiovascular disease in patients with a transplanted kidney is three to five times higher than in the general population [39]. A cardiovascular event with congestive heart failure or coronary heart disease was manifested in almost 40% of patients 36 months after kidney transplantation [9]. Cardiovascular disease is the most common cause of death in transplanted patients, accounting for 35–50% of all causes of death, and occurs at least two times more often than in the general population [40]. Most kidney recipients die with functional graft and half of these patients die due to ischemic heart disease or other vascular diseases [41].

Left ventricular hypertrophy is a risk factor for the unfavorable outcome of patients with a transplanted kidney. The selection of patients with an increased risk of left ventricular hypertrophy, the timely application of appropriate treatment, the achievement and maintenance of the target values of risk factors, lead to decrease of the development and regression of existing left ventricular hypertrophy, reduction in the rate of cardiovascular morbidity and mortality,

Cardiovascular Diseases in Patients with Renal Transplantation

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Left ventricular hypertrophy is present in most patients who begin treatment by replacing renal function and are associated with poor outcome. Time spent on dialysis can also affect the development of left ventricular hypertrophy. Transplantation of the kidneys leads to the withdrawal of left ventricular hypertrophy together with the normalization of blood pressure. The regression of left ventricular hypertrophy continues during the first 2 years after trans-

The presence of left ventricular hypertension as well as the weak systolic function of the left ventricle before transplantation are related to an increased mortality after renal transplantation during 7.5-year follow-up, while other traditional risk factors such as hypertension, hyperlipidemia and smoking did not show such a connection. On cardiography of the heart made 4 months after transplantation, only left ventricular hypertension had a strong association with

Heart failure is a clinical syndrome characterized by reduced tolerance of physical activity and overload volume. The incidence of congestive heart failure in patients with a transplanted kidney is two to five times higher than the incidence in the general population [47]. The incidence of congestive heart failure in patients with a transplanted kidney was 10.2%

In a study of Higashi and associates, 11 out of 190 (5.8%) kidney recipients, with preserved left ventricular systolic function and the presence of diastolic left ventricular dysfunction, devel-

Diastolic left ventricular dysfunction is present in 45% of patients with a transplanted kidney. The clinical presentation is the same as in all other patients with cardiac insufficiency. The following symptoms are reported: difficulty breathing, intolerance of physical activity, edema

Treatment: the first measure is to reduce physical activity and reduce salt intake. If this is not enough, medication therapy is started with a combination of diuretics, ACE inhibitors and

Ischemic heart disease (IHD) is the most common disease in the large group of all cardiovascular diseases. The prevalence of ischemic heart disease in patients with a transplanted kidney

12 months after transplantation and 18.3% 36 months after transplantation [48].

and improve the quality of life of patients with a transplanted kidney.

plantation. Older age and hypertension can slow down this process [45].

poor prognosis during monitoring [46].

oped a postoperative edema of the lungs [49].

of the lower extremities and stomach.

3.3. Ischemic heart disease

3.2. Heart failure

digitalis.

The most common cardiovascular diseases in patients after kidney transplantation are as follows: ischemic heart disease, congestive heart failure and left ventricular hypertrophy [6]. Of all cardiovascular complications, ischemic heart disease is by far the most common cause of mortality (more than 50%) in patients with a transplanted kidney [41]. Frequency of left ventricular hypertrophy ranges from 50 to 70% in patients with a transplanted kidney [42]. Left ventricular hypertrophy is associated with an increased degree of ventricular arrhythmias. In Europe, cardiovascular disease account for 36% of the total mortality of patients with a transplanted kidney [43]. In the United States, the annual mortality rate of cardiovascular diseases in these patients is 0.54% and is approximately twice as high (0.28%) than in the general population [39].

Ischemic heart disease causes 53% of deaths in patients with transplanted kidney and preserved graft function. The risk of mortality from ischemic heart disease is 6.4 times higher in nondiabetic transplanted renal patients, 8.6 times higher in dialysis patients and 20.8 times higher in transplanted renal patients with diabetes than in the general population [41]. Diagnostic strategy for early detection of patients with an increased risk of developing asymptomatic disorders of the systolic and diastolic function of the left ventricle should include: echocardiographic examination, tests for coronary artery disease and tests for the determination of myocardial function (BNP, Tt-pro BNP). In a study of Aakhus and associates on cardiovascular diseases in patients with a transplanted kidney, involving 406 patients with a transplanted kidney, the mean annual mortality was 4.4, and 74% of them were cardiovascular causes of mortality [44].

#### 3.1. Left ventricular hypertrophy

The most significant risk factors for the development of left ventricular hypertrophy are as follows: hypertension, arteriosclerosis, secondary aortic stenosis and anemia.

Left ventricular hypertrophy is a risk factor for the unfavorable outcome of patients with a transplanted kidney. The selection of patients with an increased risk of left ventricular hypertrophy, the timely application of appropriate treatment, the achievement and maintenance of the target values of risk factors, lead to decrease of the development and regression of existing left ventricular hypertrophy, reduction in the rate of cardiovascular morbidity and mortality, and improve the quality of life of patients with a transplanted kidney.

Left ventricular hypertrophy is present in most patients who begin treatment by replacing renal function and are associated with poor outcome. Time spent on dialysis can also affect the development of left ventricular hypertrophy. Transplantation of the kidneys leads to the withdrawal of left ventricular hypertrophy together with the normalization of blood pressure. The regression of left ventricular hypertrophy continues during the first 2 years after transplantation. Older age and hypertension can slow down this process [45].

The presence of left ventricular hypertension as well as the weak systolic function of the left ventricle before transplantation are related to an increased mortality after renal transplantation during 7.5-year follow-up, while other traditional risk factors such as hypertension, hyperlipidemia and smoking did not show such a connection. On cardiography of the heart made 4 months after transplantation, only left ventricular hypertension had a strong association with poor prognosis during monitoring [46].
