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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Assessment of cardiovascular risk factors after renal transplantation: a step towards reducing graft failure
1Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA.
Insights
Management of hypertension, dyslipidemia, and diabetes mellitus in renal transplant recipients is challenging. Treatment goals for blood pressure, LDL, and HbA1c were not consistently met, highlighting the need for improved strategies.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Renal allograft survival is limited by recipient death, primarily due to cardiovascular disease.
- Effective management of hypertension, dyslipidemia, and diabetes mellitus is crucial post-transplantation.
- Protocol-driven clinics aim to optimize care for renal transplant recipients.
Purpose of the Study:
- To assess the management of hypertension, dyslipidemia, and diabetes mellitus in a protocol-driven renal transplant clinic.
- To evaluate patient adherence to treatment targets for blood pressure, LDL, and HbA1c.
- To identify areas for improvement in post-transplant care.
Main Methods:
- Retrospective review of 128 renal allograft recipients (2004-2008).
- Annual assessment of blood pressure (BP), low-density lipoprotein (LDL), and hemoglobin A1c (HbA1c) for up to 5 years.
- Comparison of patient results with Kidney Disease: Improving Global Outcomes (KDIGO) guidelines; analysis of medication use.
Main Results:
- High prevalence of pre-existing hypertension (96.1%), dyslipidemia (60.9%), and diabetes mellitus (43.8%).
- At 1 year post-transplant, target BP, LDL, and HbA1c were achieved by 41.4%, 71.7%, and 70.5% of patients, respectively.
- By 5 years post-transplant, target BP, LDL, and HbA1c were achieved by 55%, 91.7%, and 88.9% of patients, respectively.
Conclusions:
- Treatment goals for BP, LDL, and HbA1c were not met in a significant number of patients, particularly within the first year.
- Even with protocols, achieving therapeutic targets remains challenging in renal transplant recipients.
- Enhanced strategies are necessary to improve outcomes and prevent complications.
Background:
Prolongation of renal allograft survival a considerable challenge. The primary cause of renal graft failure is recipient death and cardiovascular disease is the leading cause of mortality. We assessed the management of hypertension, dyslipidemia and diabetes mellitus (DM) in a protocol-driven renal transplant clinic.
Methods:
We reviewed 128 patients who received a renal allograft between 2004 and 2008 at our institution. Blood pressure (BP), low density lipoprotein (LDL) and hemoglobin AlC (HbAlC) were assessed annually for up to 5 years. Results were compared with the Kidney Disease: Improving Global Outcomes guidelines which target BP at ≤ 130/80 mmHg, LDL ≤ 100 mg/dL, and HbAlC ≤ 7.5%. Use of statins and antihypertensive medications was reviewed. Chi-square and t tests were used for analysis.
Results:
A history of hypertension, dyslipidemia, and DM were present in 96.1%, 60.9%, and 43.8%, respectively. The percentage of patients on ≥ 3 antihypertensive medications, statins, and other lipid-lowering medications were 38.01%, 44.5%, and 17.2%, respectively. One-year posttransplant targets for BP, LDL, and HbAlC were achieved in 41.4%, 71.7%, and 70.5% of patients, respectively. Five-year posttransplant target BP, LDL, and HbAlC were achieved in 55%, 91.7%, and 88.9% of patients, respectively.
Conclusions:
Even in a university-based clinic with protocols designed to improve compliance, treatment goals for BP, LDL, and HbAlC were not achieved in a substantial number of patients, especially in the first year posttransplantation. Better strategies are needed to meet treatment objectives and prevent untoward outcomes.
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