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28 September 2012

Importance of anemia in the chronic Cardiorenal syndrome: Effects on renal function after heart transplantation

Alexandre Braga LibórioABCDEF, Russian Soares UchiaABC, Alessa Peixoto AragaoABC, João David de Sousa NetoABC, Juan Miguel Cosquillo ValdiviaABC, Filipe de AlencarAB, Ricardo Everton Dias Mont’AlverneAB, Francisco Ivan Benício de Sá FilhoABC, Juan Alberto Cosquillo MejiaCDE

DOI: 10.12659/MSM.883487

Med Sci Monit 2012; 18(10): CR611-616

Abstract

Background: Cardiorenal syndrome has been recently divided into 5 categories, according to acute or chronic evolution and primary organ dysfunction. Anemia can also accompany this disorder, leading to a more complex situation. This study aims to analyze the renal outcomes of patients, specifically patients with chronic Cardiorenal syndrome, with or without anemia, long-term after heart transplantation.
Material/Methods: This was a retrospective cohort study on chronic Cardiorenal syndrome patients submitted to heart transplantation. Patients were divided according to presence of anemia and renal dysfunction before heart transplantation.
Results: A total of 108 patients (92 males) with the mean age of 45±12 years were included. The etiologies of the heart failure were hypertensive dilated myocardiopathy (66%), ischemic (14%) and Chagasic (12%). Before the heart transplantation, 51 patients had an eGFR less than 60 mL/min. From these, 24 had concomitant anemia. One year after the transplantation, patients with previous isolated renal dysfunction ameliorates eGFR (45±11 vs. 65±26 mL/min, p<0.001), while those patients with previous renal dysfunction and anemia presented no improvement (eGFR 44±14 vs. 47±13 mL/min, p=0.619) 1 year after heart transplantation. Moreover, higher hemoglobin was an independent predictor of eGFR improvement after heart transplantation when associated with previous renal dysfunction (OR 1.8; CI 1.2–3.6, p<0.01 for each hemoglobin increment of 1 g/dL).
Conclusions: Patients with isolated Cardiorenal syndrome presented partial renal function recovery after heart transplantation, while the presence of cardiorenal anemia was a marker of renal function non-recovery 1 year after heart transplantation.

Keywords: Kidney Failure, Chronic - physiopathology, Kidney - physiopathology, Heart Transplantation - adverse effects, Glomerular Filtration Rate, Chronic Disease, Cardio-Renal Syndrome - physiopathology, Anemia - physiopathology, Kidney Function Tests

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