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[Incidence of cardiovascular risk factors and complications after kidney transplantation]
1Klinik für Nephrologie und Rheumatologie, Medizinische Klinik und Poliklinik der Heinrich-Heine-Universität Düsseldorf. Ivens@med.uni-duesseldorf.de
Insights
Cardiovascular disease is a major concern post-renal transplantation. Managing risk factors like hypertension, diabetes, and obesity before and after transplantation is crucial to reduce complications.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Context:
- Cardiovascular disease (CVD) is a leading cause of mortality in renal transplant recipients (RTRs).
- The incidence of CVD is significantly higher in RTRs compared to the general population.
- Understanding CVD risk factors pre- and post-transplantation is vital for improving patient outcomes.
Purpose:
- To evaluate the incidence of atherosclerotic cardiovascular complications after renal transplantation (RTx).
- To determine the prevalence of cardiovascular risk factors before and after RTx.
- To analyze the association between these risk factors and the development of CVD complications.
Summary:
- A study of 427 RTRs (mean age 45, 58% male, 7% diabetic) from 1987-1992 found an 11.7% incidence of atherosclerotic CVD post-RTx.
- Key risk factors including hypertension, diabetes mellitus, and obesity significantly increased post-RTx.
- Independent risk factors for CVD included diabetes mellitus (RR 4.3), age >50 (RR 2.7), obesity (RR 2.6), smoking (RR 2.5), and high LDL cholesterol (RR 2.3).
Impact:
- Highlights the critical need for early and continuous management of cardiovascular risk factors in patients with renal failure and post-RTx.
- Suggests that effective risk factor treatment can potentially reduce cardiovascular morbidity and mortality in this high-risk population.
- Emphasizes the need for future prospective studies to validate treatment strategies and their impact on cardiovascular outcomes.
Background:
Cardiovascular disease is a leading cause of death after renal transplantation (RTx), and the incidence is considerably higher than in the general population. Aim of this study was to evaluate the incidence of atherosclerotic cardiovascular complications after RTx, the prevalence of cardiovascular risk factors, prior to and following RTx, and the association between the risk factors and complications.
Patients And Methods:
Analysis of atherosclerotic cardiovascular diseases (coronary artery disease, cerebral and peripheral vascular disease) and cardiovascular risk factors before and after transplantation in 427 renal transplant recipients between 1987 and 1992 (mean age at transplantation 45 +/- 12 years, 58% male, 7% diabetics) with a mean posttransplant follow-up of 28 +/- 20 months.
Results:
Following RTx 11.7% developed atherosclerotic cardiovascular diseases, the majority coronary artery disease (9.8%). The comparison of risk factors 12 months before and 24 months following transplantation showed: The prevalence of systemic hypertension (from 67% to 86%), diabetes mellitus (from 7% to 16%) and obesity with a body mass index > 25 kg/m2 (from 26% to 48%) had increased significantly whereas the number of smokers halved to 20%. The triglycerides decreased significantly (from 235 +/- 144 mg/dl to 217 +/- 122 mg/dl). The total and HDL cholesterol rose significantly (from 232 +/- 65 mg/dl to 273 +/- 62 mg/dl and from 47 +/- 29 mg/dl to 56 +/- 21 mg/dl, respectively). The LDL cholesterol increase was insignificant (from 180 +/- 62 mg/dl to 189 +/- 53 mg/dl). In the univariate analysis, cardiovascular diseases were significantly associated with male gender, age over 50 years, diabetes mellitus (DM), smoking, total cholesterol > 200 mg/dl, LDL cholesterol > 180 mg/dl, HDL cholesterol < 55 mg/dl, fibrinogen > 350 mg/dl, body mass index > 25 kg/m2, and more than 2 antihypertensive agents per day. The Cox proportional hazards model revealed DM with a relative risk (RR) of 4.3, age > 50 years (RR = 2.7), body mass index > 25 kg/m2 (RR = 2.6), smoking (RR = 2.5), and LDL cholesterol > 180 mg/dl (RR = 2.3) as independent risk factors.
Conclusions:
The high incidence of cardiovascular disease following renal transplantation is mainly due to a high prevalence and accumulation of classical risk factors before and following transplantation. The treatment of the risk factors must be effective and introduced early in the course of renal failure, further, they must be continued following transplantation. Future prospective studies should evaluate the success of treatment regarding reduction of cardiovascular morbidity and mortality in this high risk population.