Effect and correlation of patent vascular access flow on left ventricular hypertrophy in kidney transplant patients

Abstract

Background: Patency of vascular accesses (VA) is associated with left ventricular hypertrophy (LVH) in kidney transplant recipients (KTR). This level of VA flow (VAF) as related to LVH was assessed and an upward level of VA flow recommended for VA closure determined. This recommendation has not been previously reported. Methods: 123 KTR cohort patients were enrolled between August 2016 and December 2017 and their LVH and LV mass index (LVMI) by echocardiography and VAF by Doppler ultrasound were evaluated at baseline and for a 24-month follow-up period. Associations between VAF and LVH were adjusted for other factors. Results: Patients with patent VA (55.3%) had significantly greater LVH (47.1 vs. 29.1%, an adjusted odds ratio 2.44, p = 0.03) and LVMI (112.15 ± 34.4 vs. 97.55 ± 23.55 g/m2, p = 0.009) when compared with the non-VA group. A positive correlation between VAF rate and LVM was noted (r = 0.40, p < 0.001). Subgroup analysis revealed the VAF ≥ 900 ml/min had risks of LVH 3.61, and 2.86 times compared with the non-VA group and the VAF < 900 ml/min group. After a 24-month follow up, there was no significantly individual change in LVMI in patients with or without VA except 6 patients who lost their VA patency during follow-up time had a significant reduction of LVMI (120.17 ± 52.13 to 80.89 ± 22.72 g/m2, p = 0.046). Conclusions: Patency of VA in post-KT patients was associated with LVH. There was a significant reduction of LMVI after loss of VA patency. Patients with stable kidney graft function should be considered for VA closure especially if VAF is ≥ 900 ml/min.

Keywords

• Access flow rate
• Kidney transplant
• Left ventricular hypertrophy
• Vascular access