9 This risk may be explained by adverse effects of mildly reduced kidney function on cardiac and vascular function. Importantly, recent observational data have shown a small but significant increase in cardiovascular mortality in living kidney donors compared with matched healthy controls. 5, 6 Recent animal experiments demonstrated structural and functional changes and altered gene expression in the left ventricular myocardium after unilateral nephrectomy. 3, 4 Increased left ventricular mass (LVM) is an early subclinical predictor of cardiovascular disease and associated with mild kidney function impairment independent of traditional risk factors, suggesting a pathophysiological link between kidney function and cardiac patterns.
Left ventricular hypertrophy is an important cardiovascular risk factor 1, 2 and is common in chronic kidney disease. This study of a longitudinal analysis of living kidney donors provides direct evidence of a kidney–heart link. The mild decrease in kidney function after living kidney donation leads to a significant but clinically negligible increase in left ventricular mass 12 months after living kidney donation. Concurrently, kidney and adrenal gland volume increased from 163☓3 to 195☓4 mL ( P<0.001) and from 7.6☒.2 to 8.4☒.4 mL ( P=0.032), respectively, as did procollagen type III (Δ0.11 ng/mL, P<0.001) and not N-terminal probrain natriuretic peptide (Δ14 pg/mL, P=0.25). In addition, heart rate was significantly increased (65☗ to 74☑4 P=0.04).
Left ventricular mass increased from 112☒2 to 115☒3 g ( P<0.001). Mean estimated glomerular filtration rate was 102☑5 mL min −1 1.73 m −2 before donation and 70☑3 mL min −1 1.73 m −2 at 12 months ( P<0.001). In this prospective cohort study, cardiac and renal magnetic resonance imaging and laboratory analyses were performed in 23 living kidney donors (mean age 54☑0 years, 52% male) before donation and at 4 and 12 months after nephrectomy. To investigate this association, we evaluated the impact of mildly decreased kidney function after living kidney donation on subclinical cardiac structural and functional changes. In addition, mildly decreased kidney function is associated with an increase of left ventricular mass and with cardiovascular disease in patients with chronic kidney disease. Living kidney donation is associated with a small but significant increase in cardiovascular mortality. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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