Background: Chronic kidney disease (CKD) is a frequent complication after heart transplantation. The magnitude of post-transplant CKD makes it necessary to characterize patients at increased risk. Strategies to delay progression and improve outcomes, such as renoprotective medications, and timely referral to nephrology, remain an important part of providing care to heart transplant recipients (HTR) with CKD. We determined if these goals were being met in a single-centre cohort of HTR.

Methods: This single-centre, cross-sectional study examined 195 patients who received a heart transplant from 1 Jan 2000 to 30 June 2011 and followed until 31 Dec 2011. Glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and moderate or severe renal dysfunction (MSRD) was defined as GFR < 60mL/ min/1.73 m2.Multivariable logistic and linear regression models were fitted in a stepwise fashion to analyze relationships between donor, recipient and transplant factors and the outcome of renal function. Among HTR with MSRD, multivariable logistic regression models were fitted to identify independent predictors of referral to a nephrologist for CKD care. Clinical management among HTR referred vs not referred to a nephrologist were compared using descriptive statistics.

Results: Time since transplant ranged from 6 months to 11.5 years (median = 5.1 years). The prevalence of MSRD was 60%. Independent predictors of MSRD at the time of study were female sex (OR 2.68 [95% CI: 1.14, 6.32]), GFR at transplant (OR 0.78 [95% CI: 0.66, 0.93] per 10 mL/min), age at study time (OR 1.07 [95% CI: 1.04, 1.11] per year), time since transplant (OR 1.28 [95% CI: 1.10, 1.49] per year) and use of tacrolimus at the study time (OR 0.29 [95% CI: 0.09, 0.95]). These results were confirmed with linear regression models using GFR at the time of study. Among MSRD patients, 20.5% were referred to nephrology for management of CKD-related complications. Recipient GFR was the only independent predictor of nephrology referral.

Conclusions: Our results suggest that female sex, pre-transplant GFR, older age at transplant, and time since transplant may be risk factors for prevalent MSRD in HTR. Further study is required to determine whether similar associations are generalizable to other heart transplant populations.

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