Placebo Effects On 6-minute Walk Test And Peak Oxygen Consumption In Patients With Heart Failure: A Systematic Review Of Contemporary Randomized Controlled Trials
HFSA ePoster Library. Khan M. 09/10/21; 343465; 231
Munim Khan
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Abstract
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Background: Orthotropic Heart Transplantation (OHT) remains the definitive management for patients with end stage heart failure. Chronic kidney disease (CKD) is a common complication following OHT. In a non-transplant population, CKD that progresses to end stage renal failure requiring dialysis (CKD stage 5) is associated with increased morbidity and mortality. For non OHT recipients after one year on dialysis, mortality is 15-20%, and five-year survival is estimated at 50%. To date there are few large-scale studies that identify the prevalence, and risk factors associated with CKD stage 5 in patients following OHT.
Methods: This was an analysis of 53,566 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Those included in the study were adult OHT recipients greater than 18 years of age from 1987 to 2019. Patients were categorized by long-term dialysis utilization (OHT-dialysis or OHT non-dialysis). Study objectives were to identify the prevalence of long-term dialysis use, long-term survival post OHT, and factors associated with long-term dialysis use. Associations were determined using Kaplan-Meier estimations. Confounding was addressed using multivariable Cox proportional hazards models.
Results: During the study period, the prevalence of long-term dialysis use in the study population was 13% (6902 OHT recipients). The mean age for the entire population was 55 years and was similar between the two groups. OHT dialysis patients were more likely to be male (79% vs 76%, p=<0.001), Black (20% vs 16%, p=<0.001), required pre-transplant dialysis (5% vs 2%, p=<0.001), and Hepatitis C positive (3% vs 2%, p=0.002). Factors associated with long-term dialysis use included Older age at time of OHT (OR 1.004, CI 1-1.09, p=0.032), Elevated BMI (OR 1.02, CI 1.012-1.031, P<0.0001), African American Race (OR 1.59, CI 1.43-1.78, p=0.0009), Cyclosporine use (OR 1.16, CI 1.016-1.331, p=0.028), HCV positivity (OR 1.87, CI 1.53-2.28, p=<0.0001), and dialysis prior to OHT (OR 2.03, CI 1.68-2.47, p=<0.0001). Long-term dialysis use post OHT was associated with worse long-term survival (Figure 1).
Conclusion: Post OHT CKD 5 is associated with worse long-term outcomes. Further studies into modifiable risk factors are needed.
Methods: This was an analysis of 53,566 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Those included in the study were adult OHT recipients greater than 18 years of age from 1987 to 2019. Patients were categorized by long-term dialysis utilization (OHT-dialysis or OHT non-dialysis). Study objectives were to identify the prevalence of long-term dialysis use, long-term survival post OHT, and factors associated with long-term dialysis use. Associations were determined using Kaplan-Meier estimations. Confounding was addressed using multivariable Cox proportional hazards models.
Results: During the study period, the prevalence of long-term dialysis use in the study population was 13% (6902 OHT recipients). The mean age for the entire population was 55 years and was similar between the two groups. OHT dialysis patients were more likely to be male (79% vs 76%, p=<0.001), Black (20% vs 16%, p=<0.001), required pre-transplant dialysis (5% vs 2%, p=<0.001), and Hepatitis C positive (3% vs 2%, p=0.002). Factors associated with long-term dialysis use included Older age at time of OHT (OR 1.004, CI 1-1.09, p=0.032), Elevated BMI (OR 1.02, CI 1.012-1.031, P<0.0001), African American Race (OR 1.59, CI 1.43-1.78, p=0.0009), Cyclosporine use (OR 1.16, CI 1.016-1.331, p=0.028), HCV positivity (OR 1.87, CI 1.53-2.28, p=<0.0001), and dialysis prior to OHT (OR 2.03, CI 1.68-2.47, p=<0.0001). Long-term dialysis use post OHT was associated with worse long-term survival (Figure 1).
Conclusion: Post OHT CKD 5 is associated with worse long-term outcomes. Further studies into modifiable risk factors are needed.
Background: Orthotropic Heart Transplantation (OHT) remains the definitive management for patients with end stage heart failure. Chronic kidney disease (CKD) is a common complication following OHT. In a non-transplant population, CKD that progresses to end stage renal failure requiring dialysis (CKD stage 5) is associated with increased morbidity and mortality. For non OHT recipients after one year on dialysis, mortality is 15-20%, and five-year survival is estimated at 50%. To date there are few large-scale studies that identify the prevalence, and risk factors associated with CKD stage 5 in patients following OHT.
Methods: This was an analysis of 53,566 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Those included in the study were adult OHT recipients greater than 18 years of age from 1987 to 2019. Patients were categorized by long-term dialysis utilization (OHT-dialysis or OHT non-dialysis). Study objectives were to identify the prevalence of long-term dialysis use, long-term survival post OHT, and factors associated with long-term dialysis use. Associations were determined using Kaplan-Meier estimations. Confounding was addressed using multivariable Cox proportional hazards models.
Results: During the study period, the prevalence of long-term dialysis use in the study population was 13% (6902 OHT recipients). The mean age for the entire population was 55 years and was similar between the two groups. OHT dialysis patients were more likely to be male (79% vs 76%, p=<0.001), Black (20% vs 16%, p=<0.001), required pre-transplant dialysis (5% vs 2%, p=<0.001), and Hepatitis C positive (3% vs 2%, p=0.002). Factors associated with long-term dialysis use included Older age at time of OHT (OR 1.004, CI 1-1.09, p=0.032), Elevated BMI (OR 1.02, CI 1.012-1.031, P<0.0001), African American Race (OR 1.59, CI 1.43-1.78, p=0.0009), Cyclosporine use (OR 1.16, CI 1.016-1.331, p=0.028), HCV positivity (OR 1.87, CI 1.53-2.28, p=<0.0001), and dialysis prior to OHT (OR 2.03, CI 1.68-2.47, p=<0.0001). Long-term dialysis use post OHT was associated with worse long-term survival (Figure 1).
Conclusion: Post OHT CKD 5 is associated with worse long-term outcomes. Further studies into modifiable risk factors are needed.
Methods: This was an analysis of 53,566 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Those included in the study were adult OHT recipients greater than 18 years of age from 1987 to 2019. Patients were categorized by long-term dialysis utilization (OHT-dialysis or OHT non-dialysis). Study objectives were to identify the prevalence of long-term dialysis use, long-term survival post OHT, and factors associated with long-term dialysis use. Associations were determined using Kaplan-Meier estimations. Confounding was addressed using multivariable Cox proportional hazards models.
Results: During the study period, the prevalence of long-term dialysis use in the study population was 13% (6902 OHT recipients). The mean age for the entire population was 55 years and was similar between the two groups. OHT dialysis patients were more likely to be male (79% vs 76%, p=<0.001), Black (20% vs 16%, p=<0.001), required pre-transplant dialysis (5% vs 2%, p=<0.001), and Hepatitis C positive (3% vs 2%, p=0.002). Factors associated with long-term dialysis use included Older age at time of OHT (OR 1.004, CI 1-1.09, p=0.032), Elevated BMI (OR 1.02, CI 1.012-1.031, P<0.0001), African American Race (OR 1.59, CI 1.43-1.78, p=0.0009), Cyclosporine use (OR 1.16, CI 1.016-1.331, p=0.028), HCV positivity (OR 1.87, CI 1.53-2.28, p=<0.0001), and dialysis prior to OHT (OR 2.03, CI 1.68-2.47, p=<0.0001). Long-term dialysis use post OHT was associated with worse long-term survival (Figure 1).
Conclusion: Post OHT CKD 5 is associated with worse long-term outcomes. Further studies into modifiable risk factors are needed.
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