Effects of Renal Transplantation on Uraemic Cardiomyopathy

Study Overview
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Brief Summary
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Chronic kidney disease (CKD) is associated with a high risk of death and morbidity due to cardiovascular disease. Much of this is caused by left ventricular disease characterised by abnormal muscle thickness and scaring. This process appears to start early in the course of CKD and causes heart failure and dangerous abnormal heart rhythms. Previous work suggests that the process may be reversible by kidney transplantation but almost all of the studies are small, retrospective and lack scientific rigour. Furthermore, they almost all use echocardiography, which is inaccurate in patients with CKD. The investigators plan to perform the first large, prospective, controlled, blind-analysed study using cardiac magnetic resonance imaging to determine whether CKD associated cardiomyopathy is reversed by kidney transplantation and if so, whether factors such as blood pressure and mediators of metabolic bone disease/fibrosis are important in effecting this change. Greater understanding of the mechanisms responsible for CKD associated cardiomyopathy could lead to future strategies and treatments to improve the high cardiovascular mortality associated with this condition.

Official Title
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A Prospective Study of the Effects of Renal Transplantation on Uraemic Cardiomyopathy Using Magnetic Resonance Imaging.

Conditions
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Cardiomyopathies

Intervention / Treatment
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* Diagnostic Test: Cardiac MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients registered on the kidney transplant waiting list at the University Hospital Birmingham NHS Foundation Trust. Ages over 18 years Exclusion Criteria Non-standard anti-rejection treatment, post transplant. Previous history of being unable to tolerate MRI scanner. Contraindication to MRI - eg metal fragments in ey

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Transplant recipients<br>Patients undergoing live donor kidney transplant. | Diagnostic Test: Cardiac MRI<br>* Cardiac Magnetic Resonance Imaging (Siemens Skyra 3T): will be performed using protocols and techniques already in use in our group. All CMR scan derived parameters will be analysed with the investigator blinded to treatment allocation as in previous studies.<br>|
| Non-transplanted<br>Patients on the deceased donor waiting list without prospect of a live donor transplant. | Diagnostic Test: Cardiac MRI<br>* Cardiac Magnetic Resonance Imaging (Siemens Skyra 3T): will be performed using protocols and techniques already in use in our group. All CMR scan derived parameters will be analysed with the investigator blinded to treatment allocation as in previous studies.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Left Ventricular Mass | Calculated by Cardiac MRI | One year. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Native Myocardial T1 Times. | Measured using T1 mapping techniques (MOLLI) | One year. | 
| Blood Pressure | 24hr Ambulatory Blood pressure monitoring | One year. | 
| Pulse Wave Analysis. | To calculate augmentation index as a marker of arterial stiffness. | One Year |