Prevalence of chronic kidney disease in orthotopic heart transplant recipients and kidney allograft recipients using the new Chronic Kidney Disease Epidemiology Collaboration formula.

Chronic kidney disease (CKD) is an important long-term complication of all forms of nonrenal organ transplantation. The aim of this study was to assess the prevalence of kidney dysfunction among heart (n = 163) and kidney allograft recipients (n = 169) using the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, which includes age, gender, and comorbidities. The mean serum creatinine values in these populations were 1.58 ± 0.75 mg/dL and 1.36 ± 0.56 mg/dL, respectively. In heart allograft recipients mean estimated glomerular filtration rate (eGFR) by (MDRD) was 57.14 ± 26.17 mL/min, and by CKD-EPI formula was 57.44 ± 26.76 mL/min whereas in kidney allograft recipients it was 63.91 ± 25.43 mL/min and 65.20 ± 25.60 mL/min, respectively. According to the MDRD formula, stage 2 CKD was noted in 35 patients; stage 3 CKD in 79 patients, and stage 4 in 23 patients. According to the CKD-EPI formula stage 2 CKD was displayed by 35 patients; stage 3 CKD in 78 patients, and stage 4 in 23 patients. Clinically significant CKD (GFR < 60 mL/min) was observed in 62% of patients. According to the MDRD normal kidney function was present in 22 and according to the CKD-EPI formula in 27 patients. According to the MDRD formula stage 2 CKD was found in 59 kidney allograft recipients; stage 3 in 58 patients; and stage 4 in 16 patients. According to the CKD-EPI formula, stage 2 CKD was noted in 63 patients; stage 3 in 58 patients; and stage 4 in 15 patients. Clinically significant CKD was observed in 44% of patients. Using MDRD or CKD-EPI normal kidney function was found in 36 and 33 patient, respectively. CKD prevalence is extremely high among heart and kidney transplant recipients. Evaluation of renal function is important to select the appropriate strategy to reduce the cardiovascular risk.

Copeptin in relation to New York Heart Association class in heart transplant recipients and kidney transplant recipients.

Copeptin is cosynthesized with vasopressin, also known as antidiuretic hormone. It is more stable than vasopressin. Recently copeptin has been studied as a diagnostic and prognostic marker for various diseases. Among patients with destabilized heart failure, copeptin was an accurate prognostic marker for mortality. Chronic heart failure is present in more than one-third of incident dialysis patients as well as in kidney allograft recipients. The aim of this study was to assess copeptin in orthotopic heart and kidney allograft recipients in relation to New York Heart Association (NYHA) class and kidney function. The studies were performed on 134 prevalent patients including 103 males and 31 females after orthotopic heart (OHT) and 80 prevalent kidney allograft recipients including 51 males and 29 females. Glomerular filtration rate (GFR) was estimated using the simplified MDRD and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae. We measured complete blood count, urea, serum lipids, fasting glucose, creatinine, NT-proBNP using standard methods in the central laboratory of the hospital. Plasma copeptin, estimated using a commercially available kit, was correlated with kidney function parameters of creatinine, estimated GFR by MDRD and CKD-EPI, NT-proBNP and ejection fraction. Copeptin was significantly lower among kidney allograft than orthotopic heart recipients: 0.71 ± 0.13 ng/mL versus 0.99 ± 0.36 ng/mL (P < .001). Kidney allograft recipients were significantly younger, with shorter times after transplantation, but similar serum creatinine and estimated GFR values. Kidney allograft recipients displayed lower NYHA classes. Copeptin was higher in chronic kidney disease stage 4 than stage 2; similarly in NYHA class III versus I. However, these correlations did not achieve statistical significance. There was no effect of gender, diabetes, or hypertension on copeptin levels in either group of transplanted patients. Among the heart transplant population copeptin is independently associated with kidney and heart function, but not in kidney allograft recipients. It may also predict outcomes of orthotopic heart transplant patients.