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Decreased renal function is a strong risk factor for cardiovascular death after renal transplantation
Herwig-Ulf Meier-Kriesche1, Rajendra Baliga, Bruce Kaplan
1Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224. meierhu@medicine.ufl.edu.
Insights
In renal-allograft recipients, worsening kidney function after transplant significantly increases cardiovascular death risk. Serum creatinine levels at one year post-transplant are a key indicator of this risk.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Chronic kidney disease is a known risk factor for cardiovascular death.
- Cardiovascular disease is the leading cause of mortality in renal-allograft recipients.
Purpose of the Study:
- To determine if renal function significantly impacts cardiovascular death risk in renal-allograft recipients.
- To investigate the association between post-transplant renal function and mortality outcomes.
Main Methods:
- Analysis of 58,900 adult primary renal transplant recipients from the US Renal Data System (1988-1998) with at least 1 year of graft survival.
- Cox proportional-hazard models used to assess the effect of renal function (serum creatinine) on cardiovascular, infectious, and malignancy-related death.
- Adjustments made for numerous confounding variables including donor/recipient demographics, dialysis history, and transplant characteristics.
Main Results:
- Serum creatinine at 1 year post-transplant strongly predicts cardiovascular death risk.
- A serum creatinine level above 1.5 mg/dL showed a significant, progressive increase in cardiovascular death risk.
- Worsening renal function was associated with increased infectious death risk but not malignancy-related death.
Conclusions:
- Post-transplant serum creatinine at one year is a significant independent predictor of cardiovascular death.
- Renal function is a critical factor in long-term outcomes for renal transplant recipients.
Background:
Chronic kidney disease is thought to be a potential risk factor for cardiovascular death. In renal-allograft recipients, cardiovascular disease is the most significant cause of death. The purpose of this study was to investigate if renal function has a significant role in determining the risk for cardiovascular death in renal-allograft recipients.
Methods:
We analyzed 58,900 adult patients registered in the United States Renal Data System who received a primary renal transplant between 1988 and 1998 and who had at least 1 year of graft survival. The primary study endpoint was death from a cardiovascular event beyond 1 year of transplantation. Secondary endpoints were death caused by infections and malignancy-related deaths. Cox proportional-hazard models were used to estimate the effect of renal function on cardiovascular death, infectious death, and malignancy-related death while correcting for potential confounding variables, such as donor and recipient age, gender, race, cause of end-stage renal disease, length of dialysis before transplantation, year of transplantation, donor source and age, delayed graft function, and immunosuppressive regimen.
Results:
Serum creatinine values at 1 year after transplantation were strongly associated with the risk for cardiovascular death. Above a serum creatinine value of 1.5 mg/dL, there was a significant and progressive increase in the risk for cardiovascular death. The risk of cardiovascular death was significantly higher when patients who lost allograft function were included in the analysis. There was an association between worsening renal function and infectious death, but there was no association between renal function and malignancy-related death.
Conclusion:
Serum creatinine at 1 year is strongly associated with the incidence of cardiovascular death independent of known risk factors.