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Comanagement With Nephrologist Care Is Associated With Fewer Cardiovascular Events Among Liver Transplant Recipients
Patrick T Campbell1, Megan Kosirog1, Blessing Aghaulor1
1Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL.
Insights
Nephrology comanagement in liver transplant recipients with chronic kidney disease (CKD) was linked to fewer cardiovascular events. Further research is needed to understand the benefits and referral barriers for CKD care in these patients.
Area of Science:
- Nephrology
- Transplant Medicine
- Cardiovascular Medicine
Background:
- Chronic kidney disease (CKD) is a significant complication in liver transplant recipients (LTRs), increasing cardiovascular (CV) event risk.
- Subspecialty care, such as nephrology comanagement, is crucial for managing CKD and improving outcomes.
Purpose of the Study:
- To investigate the association between nephrology comanagement and the occurrence of CV events in LTRs with or at risk for CKD.
Main Methods:
- An inception cohort of 602 LTRs was analyzed from 2010-2016.
- CKD was defined by estimated glomerular filtration rate (<60 mL/min/1.73 m²) or diagnostic codes.
- Cox proportional hazard models were used to assess the impact of nephrology comanagement on CV events.
Main Results:
- The prevalence of CKD or at-risk CKD in LTRs increased from 71% in year 1 to 86% by year 6 post-transplant.
- Nephrology comanagement rates decreased over time post-transplant (35% to 28%).
- Nephrology comanagement was associated with a reduced risk of CV events (aHR, 0.57; 95% CI, 0.33-0.99).
Conclusions:
- Nephrology comanagement may reduce cardiovascular events in liver transplant recipients with CKD.
- Further prospective studies are warranted to elucidate the mechanisms behind improved outcomes and identify barriers to nephrology referral.
Abstract:
Chronic kidney disease (CKD) is associated with cardiovascular (CV) events, a leading complication in liver transplant recipients (LTRs). Timely subspecialty care is associated with improved clinical outcomes in patients with CKD. This study sought to assess associations between nephrology comanagement and CV events among LTRs at risk for or with CKD.
Methods:
LTRs with CKD plus those at risk were identified in an inception cohort at a single tertiary care network between 2010 and 2016, using electronic health record data and manual chart review. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 or International Classification of Diseases 9th or 10th revision code for CKD and at-risk CKD as estimated glomerular filtration rate 60-89 mL/min/1.73 m2. Cox proportional hazard models assessed the association between nephrology comanagement and CV events among LTRs with or at risk for CKD.
Results:
Among 602 LTRs followed for up to 6 y posttransplant, prevalence of CKD plus those at risk increased yearly (71% in year 1, 86% in year 6) (P < 0.0001). Rates of nephrology comanagement decreased yearly posttransplant (35% in year 1, 28% in year 6). In multivariable models, nephrology comanagement was associated with lower CV events (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33-0.99).
Conclusions:
Among LTRs with CKD, nephrology comanagement may be associated with lower CV events. A prospective study is needed to identify the reasons for improved outcomes and barriers to nephrology referral.
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