• 1.

    Schmiedt CW, Holzman G, Schwarz T, McAnulty JF. Survival, complications, and analysis of risk factors after renal transplantation in cats. Vet Surg. 2008;37(7):683695.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kasiske BL, Guijarro C, Massy GA, Wiederkehr MR, Ma JZ. Cardiovascular disease after renal transplantation. J Am Soc Nephrol. 1996;7(1):158165.

  • 3.

    Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57(1):307313.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Meeus F, Kourilsky O, Guerin AP, Gaudry C, Marchais SJ, London GM. Pathophysiology of cardiovascular disease in hemodialysis patients. Kidney Int Suppl. 2000;76:S140S147.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Causes of death. United States Renal Data System. Am J Kidney Dis 1998;32(2):S81S88.

  • 6.

    Bozbas H, Yildirir A, Muderrisoglu H. Cardiac enzymes, renal failure and renal transplantation. Clin Med Res. 2006;4(1):7984.

  • 7.

    Mahapatra HS, Lalmalsawma R, Singh NP, Kumar M, Tiwari SC. Cardiorenal syndrome. Iran J Kidney Dis. 2009;3(2):6170.

  • 8.

    Hekmat R, Ahmadi M, Fatehi H, Dadpour B, Fazelnejad A. Correlation between asymptomatic intradialytic hypotension and regional left ventricular dysfunction in hemodialysis patients. Iran J Kidney Dis. 2011;5(2):97102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Asp AM, Wallquist C, Rickenlund A, et al. Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: comparison with healthy subjects. Clin Physiol Funct Imaging. 2015;35(3):223230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol. 2009;53(23):21292140.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342(20):14781483.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Russo D, Corrao S, Miranda I, et al. Progression of coronary artery calcification in predialysis patients. Am J Nephrol. 2007;27(2):152158.

  • 13.

    Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration cooperative study. N Engl J Med. 1986;314(24):15471552.

    • Search Google Scholar
    • Export Citation
  • 14.

    Young JB, Neumayer HH, Gordon RD. Pretransplant cardiovascular evaluation and posttransplant cardiovascular risk 2010. Kidney In Suppl. 2010;78(118):S1S7.

    • Search Google Scholar
    • Export Citation
  • 15.

    Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int. 1995;47(3):884890.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray D, Barre PE. Outcome and risk factors of ischemic heart disease in chronic uremia. Kidney Int. 1996;49(5):14281434.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Adin CA, Gregory CR, Kyles AE, Cowgill L. Diagnostic predictors of complications and survival after renal transplantation in cats. Vet Surg. 2001;30(6):515521.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    US Renal Data System. USRDA 1991 annual report. National Institute of Diabetes and Digestive and Kidney Diseases, 1991.

  • 19.

    Raine AEG, Margreiter R, Brunner FP, et al. Report on management of renal failure in Europe, XXII, 1991. Nephrol Dial Transplant. 1992;7(suppl 2):735.

  • 20.

    Delos Santos RB, Gmurczyk A, Obhrai JS, Watnick SG. Cardiac evaluation prior to kidney transplantation. Semin Dial. 2010;23(3):324329.

  • 21.

    Hawwa N, Shrestha K, Hammadah M, Yeo PSD, Fatica R, Wilson Tang WH. Reverse remodeling and prognosis following kidney transplantation in contemporary patients with cardiac dysfunction. J Am Coll Cardiol. 2015;66(16):17791787.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Kato S, Chmielewski M, Honda H, et al. Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol. 2008;3(5):15261533.

  • 23.

    Pouchelon JL, Atkins CE, Bussadori C, et al. Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement. J Small Anim Pract 2015 56(9)537552.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Carlos Sampedrano C, Chetboul V, Gouni V, Nicolle AP, Pouchelon JL, Tissier R. Systolic and diastolic myocardial dysfunction in cats with hypertrophic cardiomyopathy or systemic hypertension. J Vet Intern Med. 2006;20:11061115.

    • Search Google Scholar
    • Export Citation
  • 25.

    Wilson HE, Jasani S, Wagner TB, et al. Signs of left heart volume overload in severely anaemic cats. J Feline Med Surg. 2010;12(12):904909.

  • 26.

    Kim EJ, Chang S, Kim SY, Huh KH, Kang S, Choi YS. Predictive value of echocardiographic abnormalities and the impact of diastolic dysfunction on in-hospital major cardiovascular complications after living donor kidney transplantation.. Int J Med Sci. 2016;13(8):620628.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Abbud-Filho M, Adams PL, Alberu J, et al. A report of the Lisbon Conference on the care of the kidney transplant recipient transplantation. Transplantation. 2007;(suppl 8):S1S22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Parfrey PS. Cardiac disease in dialysis patients: diagnosis, burden of disease, prognosis, risk factors and management. Nephrol Dial Transplant. 2000;15(suppl 5):5868.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of end-stage renal disease in the United States. Am J Kidney Dis 2005;45(1)(suppl 1):A5A7, S1–280.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Ma JZ, Ebben J, Xia H, Collins AJ. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol. 1999;10(3):610619.

  • 31.

    Walker AM, Schneider G, Yeaw J, Nordstrom B, Robbins S, Pettitt D. Anemia as a predictor of cardiovascular events in patients with elevated serum creatinine. J Am Soc Nephrol. 2006;17(8):22932298.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Murphy SW, Foley RN, Parfrey PS. Screening and treatment for cardiovascular disease in patients with chronic renal disease. Am J Kidney Dis. 1998;32(5)(suppl 3):S184S199.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Polzin DJ. Chronic kidney disease in small animals. Vet Clin North Am Small Anim Pract. 2011;41(1):1530.

  • 34.

    Weinrauch LA, D’Elia JA, Monaco AP. Preoperative evaluation for diabetic renal transplantation: impact of clinical, laboratory, and echocardiographic parameters on patient and allograft survival.. Am J Med. 1992;93(1):1928.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Kyles AE, Gregory CR, Wooldridge J, et al. Management of hypertension controls postoperative neurologic disorders after renal transplantation in cats. Vet Surg. 1999;28(6):436441.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Ponticelli C, Cucchiari D, Grazian G. Hypetension in kidney transplant recipients. Transpl Int. 2011;24(6):523533.

  • 37.

    Chetboul V, Lefebvre HP, Pinhas C, Clerc B, Boussouf M, Pouchelon J-L Spontaneous feline hypertension: clinical and echocardiographic abnormalities, and survival rate. J Vet Intern Med. 2003;17(1):8995.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Henik RA, Stepian RL, Bortnowski HB. Spectrum of M-mode echocardiographic abnormalities in 75 cats with systemic hypertension. J Am Anim Hosp Assoc. 2004;40(5):359363.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Agarwal R. Hypertension in chronic kidney disease and dialysis, pathophysiology and management. Cardiol Clin. 2005;23:237248.

  • 40.

    Rubin MF. Hypertension following kidney transplantation. Adv Chronic Kidney Dis. 2011;18(1):1722.

  • 41.

    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.. Lancet. 2002;360(9349):19031913.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Ferreira SR, Moisés VA, Tavares A, Pacheco-Silva A. Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile.. Transplantation. 2002;74(11):15801587.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Stewart GA, Gansevoort RT, Mark PB, et al. Electrocardiographic abnormalities and uremic cardiomyopathy. Kidney Int. 2005;67(1):217226.

  • 44.

    Parfrey PS, Griffiths SM, Harnett JD, et al. Outcome of congestive heart failure, dilated cardiomyopathy, hypertrophic hyperkinetic disease, and ischemic heart disease in dialysis patients.. Am J Nephrol. 1990;10(3):213221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Sugimoto K, Kawase N, Aoki T, Fujii Y. Effects of dehydration on echocardiographic diastolic parameters in healthy cats. J Vet Sci. 2019;20(3):e18. doi:10.4142/jvs.2019.20.e18

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Snell W, Aronson LR, Phillips H, Beale L, Larenza Menzies MP. Influence of anesthetic variables on short-term and overall survival rates in cats undergoing renal transplantation surgery. J Am Vet Med Assoc. 2015;247(3):267277.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Arend SM, Mallat MJ, Westerndorp RJ, van der Woude FJ, van Es LA. Patient survival after renal transplantation; more than 25 years follow-up. Nephrol Dial Transplant. 1997;12(8):16721679.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Kappes U, Schanz G, Gerhardt U, Matzkies F, Suwelack B, Hohage H. Influence of age on the prognosis of renal transplant recipients. Am J Nephrol. 2001;21(4):259263.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Ojo AO, Port FK, Wolfe RA, Mauger EA, Williams L, Berling DP. Comparative mortality risks of chronic dialysis and cadaveric transplantation in black end-stage renal disease patients. Am J Kidney Dis. 1994;24(1):5964.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Debska-Slizień A, Dudziak M, Kubasik A, Jackowiak D, Zdrojewski Z, Rutkowski B. Echocardiographic changes in left ventricular morphology and function after successful renal transplantation. Transplant Proc 2000;32(6):13651366.

    • PubMed
    • Search Google Scholar
    • Export Citation

Advertisement

Characterization of preoperative cardiovascular status and association with outcome following feline renal allograft transplantation: 166 cases

Lillian Aronson VMD, DACVS1, Heidi Phillips VMD, DACVS2, and Mark Oyama DVM, MS, DACVIM1
View More View Less
  • 1 Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
  • | 2 Department of Veterinary Clinical Medicine, Veterinary Medical Teaching Hospital, College of Veterinary Medicine, University of Illinois, Urbana, IL

Abstract

OBJECTIVES

To retrospectively evaluate preoperative historical, biochemical, and cardiovascular screening data for predictors of survival to discharge and long-term survival in feline renal allograft recipients from 1 institution.

ANIMALS

166 cats that underwent renal transplantation at the University of Pennsylvania between 1998 and 2018.

PROCEDURES

Medical records were reviewed for preoperative historical information, biochemical data, and cardiac assessment including auscultation findings, pre- and postoperative systolic blood pressure measurements, thoracic radiographic evaluation, and echocardiographic measurements. The need for hemodialysis, the number of surgical procedures, native kidney biopsy diagnosis and survival time was also recorded. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% CI. Univariable and multivariable analysis were performed to determine variables that were independently associated with survival to discharge and long-term survival.

RESULTS

The patient population primarily consisted of adult male DSH cats (70%) diagnosed with IRIS stage 4 CKD (66.3%). Abnormalities identified on preoperative cardiac assessment, including hypertension, the presence of a murmur, echocardiographic changes, and radiographic signs of congestive heart failure, were not associated with survival to discharge or long-term survival. Age was the only single significant variable associated with survival, and the risk of death increased by 11% (95% CI, 6% to 17%) for every 1 year in patient age.

CLINICAL RELEVANCE

The presence of cardiac abnormalities identified during the screening process of cats presenting for transplantation should not immediately exclude a potential candidate for the procedure. Owners considering transplantation should be educated on the impact of age on survival following surgery.

Abstract

OBJECTIVES

To retrospectively evaluate preoperative historical, biochemical, and cardiovascular screening data for predictors of survival to discharge and long-term survival in feline renal allograft recipients from 1 institution.

ANIMALS

166 cats that underwent renal transplantation at the University of Pennsylvania between 1998 and 2018.

PROCEDURES

Medical records were reviewed for preoperative historical information, biochemical data, and cardiac assessment including auscultation findings, pre- and postoperative systolic blood pressure measurements, thoracic radiographic evaluation, and echocardiographic measurements. The need for hemodialysis, the number of surgical procedures, native kidney biopsy diagnosis and survival time was also recorded. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% CI. Univariable and multivariable analysis were performed to determine variables that were independently associated with survival to discharge and long-term survival.

RESULTS

The patient population primarily consisted of adult male DSH cats (70%) diagnosed with IRIS stage 4 CKD (66.3%). Abnormalities identified on preoperative cardiac assessment, including hypertension, the presence of a murmur, echocardiographic changes, and radiographic signs of congestive heart failure, were not associated with survival to discharge or long-term survival. Age was the only single significant variable associated with survival, and the risk of death increased by 11% (95% CI, 6% to 17%) for every 1 year in patient age.

CLINICAL RELEVANCE

The presence of cardiac abnormalities identified during the screening process of cats presenting for transplantation should not immediately exclude a potential candidate for the procedure. Owners considering transplantation should be educated on the impact of age on survival following surgery.

Contributor Notes

Corresponding author: Dr. Aronson (laronson@vet.upenn.edu)