Kidney Transplant; Complications

Cardiovascular Diseases

This analysis will be performed at baseline using the portable whole-body multifrequency bioimpedance analysis device (BCM®Body Composition Monitor - Fresenius Medical Care D GmbH). The technique involves attaching electrodes to the patient's forearm and ipsilateral ankle, with the patient in a supine position. The BCM® measures the body resistance and reactance to electrical currents of 50 discrete frequencies, ranging between 5 and 1000 kHz. Based on a fluid model using these resistances, the extracellular water (ECW), the intracellular water (ICW) and the total body water (TBW) are calculated. These volumes are then used to determine the amount of fluid overload. All calculations are automatically performed by the software of the BCM® device. In addition, this analysis will provide the LTI and FTI for the included patients.

Bioimpedance Spectroscopy

Arterial stiffness assessment will be performed by applanation tonometry (SphygmoCorTM; PWV Inc., Westmead, Sydney, Australia) with the patient being recumbent, 10 minutes before the measures were done. The carotid and femoral pulse will be acquired by applanation tonometry sequentially, allowing a single operator to acquire the measurement. The transit time from the R-wave of the simultaneously acquired electrocardiogram to the foot of the carotid and femoral pulse is measured. The difference acquired electrocardiogram to the foot of the carotid and femoral pulse is measured. The difference between these 2 transit times is divided by distances measured from the body surface to estimate the arterial path length in order to calculate carotid-femoral PWV.

Arterial Stiffness

Echocardiographic evaluations will be made in each patient at baseline. All echocardiographic measurements will be carried out according to the recommendations of the American Society of Echocardiography by an observer unaware of the lung ultrasound and bioimpedance results. Echocardiographic evaluation will provide information about cardiac anatomy (e.g. volumes, geometry, mass) and function (e.g. left ventricular function and wall motion, valvular function, right ventricular function, pulmonary artery pressure, pericardium).

Echocardiography

Examinations will be performed in the supine position. Scanning of the anterior and lateral chest will be performed on both sides of the chest, from the second to the fourth (on the right side to the fifth) intercostal spaces, at parasternal to mid-axillary lines. B-lines will be recorded in each intercostal space and were defined as a hyperechoic, coherent US bundle at narrow basis going from the transducer to the limit of the screen. B-lines starting from the pleural line can be either localized or scattered to the whole lung and be present as isolated or multiple artifacts. The sum of B-lines produces a score reflecting the extent of lung water accumulation (0 being no detectable B-line).

Lung ultrasonography

"Dr. C.I. Parhon" Hospital

Romanian Kidney Transplant Cardiovascular Risk Registry

The Complex Evaluation of the Cardiovascular Risk in the Kidney Transplant Patients

Doubling of creatinine or dialysis initiation.

Time to first non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, or cardiovascular death

The impact of baseline characteristics on eGFR (as assessed by the CKD-EPI formula) evolution

The impact of baseline characteristics on proteinuria (as assessed by the urine protein to creatinine ratio) evolution

Dimitrie Siriopol

Associate Professor

Grigore T. Popa University of Medicine and Pharmacy

Patients must fulfill Framingham and/or Boston criteria for heart failure and have systolic or diastolic disfunction in rest echocardiography.

Patients must have a biopsy proven diagnosis of liver cirrhosis or the diagnosis established on clinical basis in cases of known etiology of liver disease, peripheral signs of chronic liver disease, esophageal varices at endoscopy and an imaging method with evidence of cirrhosis.

Patients must fulfill stringent diagnostic criteria for the cause of ascites, by clinical criteria, laboratory and imaging tests and histology when appropriate.

Patients must fulfill the aforementioned criteria for both conditions.

Heart Failure

Liver Cirrhosis

Ascites

Carcinomatosis

BNP, SAAG, ascites total protein, echocardiography

Federal University of Espirito Santo

Hospital das Clinicas. University of São Paulo

B-type Natriuretic Peptide in the Diagnosis of Heart Failure Related Ascites

ROC curves of different strategies with and without BNP levels for diagnosing heart failure as the cause of ascites.
Sensitivity, specificity, accuracy, predictive values, likelihood ratios.

pleural effusion/triglyceride

Romanian Kidney Transplant Cardiovascular Risk Registry

B-type Natriuretic Peptide in the Diagnosis of Heart Failure Related Ascites

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