Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation
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Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation Joseph Bayne 1 & Michael Francke 2 & Elaine Ma 3 & Geoffrey A. Rubin 3 & Uma Mahesh R. Avula 3 & Haajra Baksh 3 & Raymond Givens 3 & Elaine Y. Wan 3 Received: 19 July 2020 / Revised: 20 October 2020 / Accepted: 20 October 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Objectives This study examined whether African American race was associated with an elevated risk of chronic kidney disease (CKD) post-cardiac transplantation. Background CKD often occurs after cardiac transplantation and may require renal replacement therapy (RRT) or renal transplant. African American patients have a higher risk for kidney disease as well as worse post-cardiac transplant morbidity and mortality. It is unclear, however, if there is a propensity for African Americans to develop CKD after cardiac transplant. Methods The Institutional Review Board of Columbia University Medical Center approved the retrospective study of 151 adults (57 African American and 94 non-African American) who underwent single-organ heart transplant from 2013 to 2016. The primary outcome was a decrease in estimated glomerular filtration rate (eGFR), development of CKD, and end-stage renal disease (ESRD) requiring RRT after 2 years. Results African American patients had a significant decline in eGFR post-cardiac transplant compared to non-African American patients (− 34 ± 6 vs. − 20 ± 4 mL/min/1.73 m2, p < 0.0006). African American patients were more likely to develop CKD stage 2 or worse (eGFR < 90 mL/min/1.73 m2) than non-African American patients (81% vs. 59%, p < 0.0005). Conclusions This is the first study to report that African American patients are at a significantly higher risk for eGFR decline and CKD at 2 years post-cardiac transplant. Future investigation into risk reduction is necessary for this patient population. Keywords Heart transplant . Renal dysfunction . Chronic kidney disease . Racial disparity
Introduction Cardiac transplantation is a lifesaving operation for patients with end-stage heart failure and carries a higher posttransplant median survival than other solid organ transplants [1, 2]. Despite improved patient longevity and quality of life in the modern era, there are still certain demographic and clinical risk factors associated with increased morbidity and mortality after transplant. Elucidating such risk factors may allow for Joseph Bayne and Michael Francke contributed equally to this work. * Elaine Y. Wan [email protected] 1
Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
2
Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
3
Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY 10032, USA
improved monitoring, early intervention, and prevention of poor outcomes in vulnerable cardiac transpla
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