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Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden
Francesco Reggiani1,2, Gabriella Moroni1, Claudio Ponticelli3
1Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Insights
Cardiovascular disease is a leading cause of death after kidney transplants. Managing modifiable risk factors, both traditional and new, is key to improving survival and graft function.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Science
Background:
- Cardiovascular disease (CVD) is a significant complication and leading cause of mortality post-kidney transplantation.
- Understanding CVD risk factors in this vulnerable population is critical.
Purpose of the Study:
- To review the multifactorial pathogenesis of cardiovascular disease in kidney transplant recipients.
- To identify traditional and non-traditional modifiable risk factors contributing to CVD post-transplantation.
Main Methods:
- Literature search conducted in the National Institutes of Health library of medicine.
- Included relevant articles from transplant, cardiologic, and nephrological journals.
Main Results:
- CVD pathogenesis is multifactorial, influenced by non-modifiable factors (age, gender, genetics) and modifiable factors.
- Traditional factors (diabetes, hypertension, dyslipidemia) and non-traditional factors (hyperuricemia, inflammation, low Klotho, high FGF23, vitamin D deficiency, vascular calcifications, anemia, poor physical activity) exacerbate CVD.
- Immunosuppressants and impaired graft function significantly influence comorbidity exacerbation.
Conclusions:
- Effective management of established and novel modifiable risk factors is essential for preventing CVD complications.
- Reducing cardiovascular risk improves life expectancy, quality of life, and allograft function and survival.
Background:
Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population.
Material And Methods:
We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals.
Results:
The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life.
Conclusions:
The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.
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