Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study shows that a kidney transplant can reverse heart failure

06.04.2005


University of Maryland study may change traditional thinking about offering kidney transplants to dialysis patients whose hearts do not pump effectively



Doctors at the University of Maryland Medical Center say that contrary to conventional thinking, a kidney transplant can significantly improve the heart function of people on dialysis with a serious form of heart failure. In a study published in the April 5, 2005 issue of the Journal of the American College of Cardiology, the researchers found that a majority of patients who had systolic heart failure, in which the heart’s left ventricle was weak and not pumping blood efficiently, had a dramatic recovery after their kidney transplant.

"These findings are contrary to conventional thinking that a kidney transplant may put additional strain on the hearts of patients with systolic heart failure," says the lead author of the study, Ravinder K. Wali, M.D., a nephrologist at the University of Maryland Medical Center and assistant professor of medicine at the University of Maryland School of Medicine. "We were surprised to find that, in fact, many of those people with severe heart failure had striking improvement in terms of cardiac function after a kidney transplant."


Dr. Wali adds, "Our study also found that systolic heart failure was more likely to be reversed if patients received a transplant soon after they began dialysis to treat their kidney failure."

The study followed 103 patients between June 1998 and November 2002. Prior to their transplant, all of the patients had congestive heart failure with a left ventricular ejection fraction of 40 percent or less. The ejection fraction is a measure of the ability of the heart to pump blood. In the normal ejection fraction, the heart is capable of pumping more than 55 percent of the blood volume in the ventricle. The researchers assessed the heart’s pumping ability of the patients at six and 12 months and at a later follow-up visit after successful transplantation.

Overall, after a kidney transplant, the heart’s pumping ability improved in more than 86 percent of the patients. For 70 percent of the patients, pumping ability returned to normal or close to normal following the transplant. Even more dramatic, the majority of the patients with the worst heart failure (about 20 percent of those studied) regained significant cardiac function following the transplant, according to Dr. Wali.

The investigators also observed major recovery in patients whose heart failure included blocked or narrowed heart arteries, a condition known as ischemic heart failure. "We showed that the ejection fraction went up even among those who had undergone coronary artery bypass surgery," says Dr. Wali.

The most important factor that directly affected recovery of the heart function was the length of time the patient was on dialysis. The study was not large enough to determine how long a person can remain on dialysis and still receive a cardiac benefit from a kidney transplant.

"Our conclusion," says Dr. Wali, "is that your best chance of survival, if you have both kidney failure and heart failure, is to receive a kidney transplant as soon as possible." He says this group of patients should be encouraged to seek a living kidney donor since the national waiting time for a deceased donor kidney transplant can average three to five years, according to the United Network for Organ Sharing.

Dr. Wali says it is not clear why prolonged dialysis reduces the benefits of kidney transplantation for the heart, but he says there are several toxins associated with end-stage renal disease that have an adverse effect on the muscles of the heart. It may be that some of those toxins are not totally eliminated during the process of dialysis and that long-term exposure to those toxins increases the risk of death from cardiac causes.

In an editorial accompanying the article in the Journal of the American College of Cardiology, the authors underscore the complexity of heart-kidney interactions and point to the need for further study. "The clinical implications of the study lend credence to the notion that renal transplantation can be performed safely in patients with advanced stages of heart failure due to left ventricular dysfunction," says the editorial.

The editorial was written by Hector O. Ventura, M.D., F.A.C.C., of the Ochsner Clinic Foundation in New Orleans and Mandeep R. Mehra, M.D., F.A.C.C., formerly of Ochsner, who is now head of cardiology at the University of Maryland Medical Center and professor of medicine and head of the Division of Cardiology at the University of Maryland School of Medicine.

In an interview, Dr. Mehra said, "This is an amazing study. It reverses the usual sequence of scientific inquiry from laboratory bench to patient bedside. Instead, astute observation at the bedside is prompting investigators to the laboratory, where they can systematically seek to understand why kidney transplantation successfully treats heart failure."

Bill Seiler | EurekAlert!
Further information:
http://www.umm.edu

More articles from Studies and Analyses:

nachricht New study first to predict which oil and gas wells are leaking methane
21.12.2018 | University of Vermont

nachricht Droughts boost emissions as hydropower dries up
21.12.2018 | Stanford's School of Earth, Energy & Environmental Sciences

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Flying Optical Cats for Quantum Communication

Dead and alive at the same time? Researchers at the Max Planck Institute of Quantum Optics have implemented Erwin Schrödinger’s paradoxical gedanken experiment employing an entangled atom-light state.

In 1935 Erwin Schrödinger formulated a thought experiment designed to capture the paradoxical nature of quantum physics. The crucial element of this gedanken...

Im Focus: Nanocellulose for novel implants: Ears from the 3D-printer

Cellulose obtained from wood has amazing material properties. Empa researchers are now equipping the biodegradable material with additional functionalities to produce implants for cartilage diseases using 3D printing.

It all starts with an ear. Empa researcher Michael Hausmann removes the object shaped like a human ear from the 3D printer and explains:

Im Focus: Elucidating the Atomic Mechanism of Superlubricity

The phenomenon of so-called superlubricity is known, but so far the explanation at the atomic level has been missing: for example, how does extremely low friction occur in bearings? Researchers from the Fraunhofer Institutes IWM and IWS jointly deciphered a universal mechanism of superlubricity for certain diamond-like carbon layers in combination with organic lubricants. Based on this knowledge, it is now possible to formulate design rules for supra lubricating layer-lubricant combinations. The results are presented in an article in Nature Communications, volume 10.

One of the most important prerequisites for sustainable and environmentally friendly mobility is minimizing friction. Research and industry have been dedicated...

Im Focus: Mission completed – EU partners successfully test new technologies for space robots in Morocco

Just in time for Christmas, a Mars-analogue mission in Morocco, coordinated by the Robotics Innovation Center of the German Research Center for Artificial Intelligence (DFKI) as part of the SRC project FACILITATORS, has been successfully completed. SRC, the Strategic Research Cluster on Space Robotics Technologies, is a program of the European Union to support research and development in space technologies. From mid-November to mid-December 2018, a team of more than 30 scientists from 11 countries tested technologies for future exploration of Mars and Moon in the desert of the Maghreb state.

Close to the border with Algeria, the Erfoud region in Morocco – known to tourists for its impressive sand dunes – offered ideal conditions for the four-week...

Im Focus: Programming light on a chip

Research opens doors in photonic quantum information processing, optical signal processing and microwave photonics

Researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) have developed a new integrated photonics platform that can...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Our digital society in 2040

16.01.2019 | Event News

11th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Aachen, 3-4 April 2019

14.01.2019 | Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

 
Latest News

Velcro for human cells

16.01.2019 | Life Sciences

Kiel physicists discover new effect in the interaction of plasmas with solids

16.01.2019 | Physics and Astronomy

The pace at which the world’s permafrost soils are warming

16.01.2019 | Earth Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>