Background: Heart failure (HF) after kidney transplantation is a significant but understudied problem. Pretransplant dialysis modality could influence incident HF risk through differing cardiac stressors. However, whether pretransplant dialysis modality is associated with the development of posttransplant HF is unknown. Methods: We used the US Renal Data System to assemble a cohort of 27,701 patients who underwent their first kidney transplant in the USA between the years 2005 and 2012 and who had Medicare fee-for-service coverage for #x3e;6 months preceding their transplant date. Patients with any HF diagnosis prior to transplant were excluded. Detailed baseline patient characteristics and comorbidities were abstracted. The outcome of interest was de novo posttransplant HF. Pretransplant dialysis modality was defined as the dialysis modality used at the time of transplant. We conducted time-to-event analyses using Cox regression. Death was treated as a competing risk in the study’s primary analysis. Graft failure was included as a time-varying covariate. Results: Among eligible patients, 81% were treated with hemodialysis prior to transplant, and hemodialysis patients were more likely to be male, had a shorter dialysis vintage, and had more diabetes and vascular disease diagnoses. When adjusted for all available demographic and clinical data, pretransplant treatment with hemodialysis (vs. peritoneal dialysis) was associated with a 19% increased risk in de novo posttransplant HF, with sub-distribution HR 1.19 (95% CI: 1.09–1.29). Conclusions: Our results suggest that choice of pretransplant dialysis modality may impact the development of posttransplant HF.
Cardiorenal Med

中文翻译：

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肾移植前透析方式与新发移植后心力衰竭的关联

背景：肾移植后的心力衰竭 (HF) 是一个重要但未被充分研究的问题。移植前透析方式可通过不同的心脏应激源影响心衰风险。然而，移植前透析方式是否与移植后心衰的发生有关尚不清楚。方法：我们使用美国肾脏数据系统收集了 27,701 名患者的队列，这些患者在 2005 年至 2012 年期间在美国接受了首次肾移植，并且在移植日期前 6 个月享有医疗保险按服务收费 #x3e;。移植前诊断为心衰的患者被排除在外。详细的基线患者特征和合并症被抽象出来。感兴趣的结果是从头移植后 HF。移植前透析方式定义为移植时使用的透析方式。我们使用 Cox 回归进行了事件发生时间分析。在该研究的主要分析中，死亡被视为竞争风险。移植失败作为时变协变量包括在内。结果：在符合条件的患者中，81% 的患者在移植前接受了血液透析治疗，并且血液透析患者更可能是男性，透析时间更短，并且有更多的糖尿病和血管疾病诊断。根据所有可用的人口统计和临床数据进行调整后，移植前血液透析治疗（与腹膜透析相比）与移植后新发 HF 的风险增加 19% 相关，亚分布 HR 为 1.19（95% CI：1.09-1.29）。结论：我们的结果表明，移植前透析方式的选择可能会影响移植后心衰的发展。
心肾医学