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Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation

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 pa...

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Autores principales: Ting, Stephen M. S., Iqbal, Hasan, Hamborg, Thomas, Imray, Chris H. E., Hewins, Susan, Banerjee, Prithwish, Bland, Rosemary, Higgins, Robert, Zehnder, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664577/
https://www.ncbi.nlm.nih.gov/pubmed/23724043
http://dx.doi.org/10.1371/journal.pone.0064335
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author Ting, Stephen M. S.
Iqbal, Hasan
Hamborg, Thomas
Imray, Chris H. E.
Hewins, Susan
Banerjee, Prithwish
Bland, Rosemary
Higgins, Robert
Zehnder, Daniel
author_facet Ting, Stephen M. S.
Iqbal, Hasan
Hamborg, Thomas
Imray, Chris H. E.
Hewins, Susan
Banerjee, Prithwish
Bland, Rosemary
Higgins, Robert
Zehnder, Daniel
author_sort Ting, Stephen M. S.
collection PubMed
description 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 (VO(2)AT) 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 41.7±14.5 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 (VO(2)AT) 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 receiver-operating-characteristic curve was 0.93, based on a risk prediction model that incorporated VO(2)AT, 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 VO(2)AT has the potential to predict perioperative morbidity in kidney transplant recipients.
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spelling pubmed-36645772013-05-30 Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation Ting, Stephen M. S. Iqbal, Hasan Hamborg, Thomas Imray, Chris H. E. Hewins, Susan Banerjee, Prithwish Bland, Rosemary Higgins, Robert Zehnder, Daniel PLoS One Research Article 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 (VO(2)AT) 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 41.7±14.5 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 (VO(2)AT) 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 receiver-operating-characteristic curve was 0.93, based on a risk prediction model that incorporated VO(2)AT, 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 VO(2)AT has the potential to predict perioperative morbidity in kidney transplant recipients. Public Library of Science 2013-05-27 /pmc/articles/PMC3664577/ /pubmed/23724043 http://dx.doi.org/10.1371/journal.pone.0064335 Text en © 2013 Ting et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Ting, Stephen M. S.
Iqbal, Hasan
Hamborg, Thomas
Imray, Chris H. E.
Hewins, Susan
Banerjee, Prithwish
Bland, Rosemary
Higgins, Robert
Zehnder, Daniel
Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title_full Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title_fullStr Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title_full_unstemmed Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title_short Reduced Functional Measure of Cardiovascular Reserve Predicts Admission to Critical Care Unit following Kidney Transplantation
title_sort reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664577/
https://www.ncbi.nlm.nih.gov/pubmed/23724043
http://dx.doi.org/10.1371/journal.pone.0064335
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