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Published on: April 28, 2013
Evaluation of atherosclerosis in renal transplanted patients by non-invasive methods
Cláudio Domênico Sahione Schettino1, Aristarco Gonçalves Siqueira Filho, Romeu Cortes Domingues
1Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. cdomenico@gaveacor.com.br
Insights
Endothelial dysfunction is common in renal transplant patients, detected by brachial reactivity (86.7%). Atherosclerosis markers like carotid plaque (33.3%) and coronary calcium score (20%) were less frequent, showing no correlation.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Biology
Background:
- Endothelial dysfunction is an early indicator of atherosclerosis.
- Renal transplant recipients are at increased risk for cardiovascular disease.
Purpose of the Study:
- To evaluate atherosclerosis in renal transplant patients using coronary calcium score, carotid duplex scan, and brachial reactivity.
- To assess the prevalence of endothelial dysfunction and its correlation with traditional atherosclerosis markers in this population.
Main Methods:
- A study involving 30 male renal transplant patients with stable renal function (mean age 41.3 years).
- Assessment of atherosclerotic load using coronary calcium score, carotid duplex scan, and brachial reactivity via ultrasonography.
Main Results:
- Brachial reactivity indicated significant endothelial dysfunction in 86.7% of patients.
- Carotid plaque was detected in 33.3% and coronary calcium score in 20% of patients.
- No correlation was found between high rates of endothelial dysfunction and the evaluated atherosclerosis markers.
Conclusions:
- Traditional markers like carotid plaque and coronary calcium score were infrequent in renal transplant patients.
- Brachial reactivity is a sensitive method for detecting endothelial dysfunction in this population.
- Further research is needed to understand the discrepancy between endothelial dysfunction and structural atherosclerosis markers in renal transplant recipients.
Background:
Endothelial dysfunction can be considered an early atherogenic event.
Objective:
To assess atherosclerosis in renal transplanted patients through the coronary calcium score, carotid duplex scan and brachial reactivity through ultrasonography.
Methods:
We assessed 30 renal transplanted male patients with stable renal function, with a mean age of 41.3 years.
Results:
The detection of the atherosclerotic load in this population was very significant when the brachial reactivity technique was used (86.7%); it was less frequent when based on the presence of carotid plaque (33.3%) or the coronary calcium score (20%). The carotid plaque was considered when the thickness was > 12 mm. The coronary calcium score was abnormal when > 80 according to the Agatston scale, being observed in a low percentage of patients (21.7%), possibly due to the fact that the tomography is not the ideal method to detect atherosclerosis in renal patients, as it does not differentiates intimal calcifications of the medial layer. The adequate clinical control, the low age range and the factors related to the time of pre-transplant dialysis or the anti-inflammatory effect of the post-transplant drugs can delay the onset of the calcifications.
Conclusion:
The evaluation of the atherosclerotic load through the carotid duplex scan (33,3%) and the coronary calcium score (20%) was not frequent; there was no correlation with the high rate of endothelial dysfunction detection observed with the brachial reactivity assessment (86.7%).
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