After kidney graft, heart failure may improve

Patients with end-stage kidney disease and advanced heart failure who undergo a kidney transplant tend to see an improvement in their heart function, researchers report.

Congestive heart failure is common in people with kidney failure being treated by dialysis, lead investigator Dr. Ravinder K. Wali.

In fact, heart failure may be up to 36 times more common in dialysis patients than in the general population, note Wali, at the University of Maryland School of Medicine, Baltimore, and colleagues in the Journal of the American College of Cardiology.

"Dialysis patients with severe degree of heart failure are considered to be poor candidates for kidney transplantation," Wali explained.

To evaluate whether such patients are really at increased risk of cardiac and surgical complications, the researchers followed 103 dialysis patients with heart failure who underwent kidney transplantation.

One year later, almost 70 percent of the patients had virtually normal cardiac capacity.

The researchers also found that a longer duration of dialysis decreased the likelihood of regaining normal heart function.

"In fact," concluded Wali, "kidney transplantation is perhaps the treatment of choice in such patients."

In an accompanying editorial, two physicians from the Ochsner Clinic Foundation, New Orleans, express some reservations, but conclude the findings "lend credence to the notion that renal transplantation can be performed safely in patients with advanced stages of heart failure."

SOURCE: Journal of the American College of Cardiology, April 5, 2005.