MedicalResearch.com Interview with:
W.H. Wilson Tang, MD, FACC
Assistant Professor in Medicine,
Cleveland Clinic Lerner College of Medicine
Staff, Section of Heart Failure & Cardiac Transplant Medicine
Assistant Program Director, General Clinical Research Center
The Cleveland Clinic Cleveland, OH
Medical Research: What is the background for this study? What are the main findings?
Dr. Tang: Cardiac function is a key determinant of outcomes after surgery, especially transplantation. End-stage renal disease (ESRD) poses a unique scenario, as the metabolic and uremic derangements that result from this condition lead to adverse cardiac remodeling, and kidney transplantation offers a potential for reverse remodeling. We studied patients who underwent kidney transplantation and found that echocardiogram following transplantation demonstrated consistent and significant improvement in cardiac structure and function. Post-transplant improvement in anemia was a vital factor that independently predicted such positive changes, whereas post-transplant changes in blood pressure, renal function at 12 months, and dialysis duration duration did not. Moreover, patients that demonstrated reverse remodeling had outcomes comparable to those with normal baseline cardiac function.
Medical Research: What should clinicians and patients take away from your report?
Dr. Tang: As clinicians who take care of patients with ESRD, mild to moderate cardiac dysfunction should not necessarily be a prohibitive factor to kidney transplantation. Our study suggests that anemia may be the key link to the cardiorenal interaction observed in patients with ESRD.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Tang: In recent years there has been an interest in the role of iron deficiency anemia in patients with heart failure. Studies have highlighted the beneficial cardiac therapeutic effects of treatment of iron deficiency. Future studies should assess the impact of iron deficiency in patients with cardiorenal syndrome in the pre- and post-transplant period. Studies should also continue to assess additional factors associated with reverse remodeling.
Hawwa N, Shrestha K, Hammadah M, Yeo P, Fatica R, Tang W. Reverse Remodeling and Prognosis Following Kidney Transplantation in Contemporary Patients With Cardiac Dysfunction. J Am Coll Cardiol.2015;66(16):1779-1787. doi:10.1016/j.jacc.2015.08.023.
W.H. Wilson Tang, MD, FACC (2015). ESRD Patients May Experience Cardiac Improvement After Transplant