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Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation
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Iqbal, H. (Hasan), Ting, Stephen M. S. , Hamborg, Thomas, Imray, C. (Chris), Hewins, Susan, Banerjee, Prithwish, Bland, R. (Rosemary), Higgins, Rob and Zehnder, Daniel (2013) Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation. PLoS One, Volume 8 (Number 5). Article number e64335. doi:10.1371/journal.pone.0064335
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WRAP_Ting_journal.pone.0064335.pdf - Published Version Available under License Creative Commons Attribution. Download (745Kb) | Preview |
Official URL: http://dx.doi.org/10.1371/journal.pone.0064335
Abstract
Background: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is
able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if
functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO2AT) could identify these patients.
Methods: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed
CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial
applanation tonometry were performed.
Results: There were 70 participants (age 41.7614.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were
desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced
anaerobic threshold (VO2AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27–0.68; p,0.001) and
in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12–0.59; p = 0.001). The area under the receiveroperating-
characteristic curve was 0.93, based on a risk prediction model that incorporated VO2AT, body mass index and
desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU
admission.
Conclusions: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a
preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO2AT has the
potential to predict perioperative morbidity in kidney transplant recipients.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > RD Surgery R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Kidneys -- Transplantation, Preoperative care, Cardiovascular system -- Diseases -- Diagnosis, Postoperative care | ||||
| Journal or Publication Title: | PLoS One | ||||
| Publisher: | Public Library of Science | ||||
| ISSN: | 1932-6203 | ||||
| Official Date: | 27 May 2013 | ||||
| Dates: |
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| Volume: | Volume 8 | ||||
| Number: | Number 5 | ||||
| Page Range: | Article number e64335 | ||||
| DOI: | 10.1371/journal.pone.0064335 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access | ||||
| Funder: | British Heart Foundation | ||||
| Grant number: | PG/11/66/28982 |
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