Traditional cardiovascular risk factors as clinical markers after kidney transplantation

Risk of cardiovascular disease associated with refractory hypertension in renal transplant recipients

BACKGROUND

Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis.

OBJECTIVE

To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year.

PATIENTS AND METHODS

Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed.

RESULTS

Refractory hypertension was associated with male sex (82.5% vs 66.5% [P<.01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m2 vs 49.2 [18.0] mL/min/1.73 m2 [P=.000]; and steroid therapy (94.7% vs 79.0% [P=.001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P=.03).

CONCLUSION

Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.

Chronic renal disease in renal transplant patients: management of cardiovascular risk factors

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The aim of this study was to determine the prevalence of cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, chronic kidney disease, and obesity, and the impact of their control among 526 stable renal transplant recipients according to the guidelines in the general population. Mean blood pressure was 133 +/- 16/81 +/- 9 mm Hg. The proportion of patients on antihypertensive therapy was 75%, and on ACE inhibitors or angiotensin II receptor blockers, 26%. The mean cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were 195 +/- 41, 115 +/- 32, 51 +/- 17, and 137 +/- 75 mg/dL, respectively. The proportion of patients on statin treatment was 49.7%, and those with body mass indices between 25 and 30, 30 and 35, and >35 kg/m(2) were 35%, 15%, and 4%. We observed a high prevalence of chronic kidney disease, hypertension, dyslipidemia, and obesity among renal transplant patients. Suboptimal control was frequent and control of some of these complications was far below targets established for nontransplant patients despite progressive intensification of therapy with functional graft decline. The findings of this study may have an impact on the management of renal transplant recipients.

Weight Gain Post–Renal Transplantation and Its Association With Glomerular Filtration Rate

OBJECTIVE

Obesity may be a risk factor for renal graft loss. The purpose of this study was to assess weight gain and its association with glomerular filtration rate after kidney transplant.

METHODS

This retrospective analysis of 152 adult renal transplant outpatients (77 males, 75 females; mean age, 45.6 +/- 10.1 years) with at least 6 months posttransplantation (post-tx) included body weight and creatinine clearance (CrCl) measured pretransplantation (pre-tx) as well as at 6 months (post-tx1), 1 year (post-tx2), 5 years (post-tx3), 10 years (post-tx4), 15 years (post-tx5), and 20 years (post-tx6) post-tx. Weight gain was determined by subtracting patient preoperative weight from the post-tx weights.

RESULTS

The weight gain post-tx versus pre-tx was progressive and significant (P < .001) post-tx1, 8.7 +/- 10.9% (n = 152); post-tx2, 12.4 +/- 11.5% (n = 150); post-tx3, 16.6 +/- 14.8% (n = 102); post-tx4, 20.1 +/- 18.1% (n = 47); post-tx5, 20.8 +/- 19.8% (n = 17); and post-tx6, 21.0 +/- 32.5% (n = 11). There was a positive and significant correlation between weight gain and CrCl during most times post-tx: post-tx2 (r = 0.32; P < .000); post-tx3 (r = 0.54; P < .0001); post-tx4 (r = 0.47; P = .01); and post-tx6 (r = 0.92; P < .001).

CONCLUSIONS

There was a great increase in body weight after kidney transplantation. The excessive body weight gain was associated with a better glomerular filtration rate.

Prevalence of Risk Factors for Cardiovascular Disease in Brazilian Renal Transplant Recipients

OBJECTIVE

Cardiovascular disease (CVD) is the major cause of death in renal transplant recipients. The aim of this study was to assess the prevalence of CVD risk factors among Brazilian adult renal transplant recipients.

METHODS

This cross-sectional study included 192 cases in which the evaluated CVD risk factors were hypertension, diabetes mellitus, impaired fasting glucose, obesity, overweight, abdominal obesity, metabolic syndrome, and dyslipidemia.

RESULTS

Hypertension, abdominal obesity, and hypercholesterolemia were the highest prevalent risk factors among the total population with prevalences of approximately 60%. The prevalence of obesity was significantly higher (P < .001) in recipients with normal graft function (28%) than in those with impaired graft function (7%). Abdominal obesity was also higher (P = .02) in the normal graft function group (77%) than in recipients with creatinine clearance (CrCl) values <60 mL/min (61%). There were positive, significant correlations between CrCl and body mass index (BMI) (r = 0.47; P < .001) and between CrCl and waist circumference (WC) (r = 0.44; P < .001). BMI (r = 0.31; P < .001) and WC (r = 0.27; P < .001) were also positively associated with triglyceride levels. There were negative associations of high-density lipoprotein (HDL)-cholesterol (HDL-c) with BMI (r = -0.28; P < .01) and WC (r = -0.32; P < .01).

CONCLUSIONS

The high prevalence of CVD risk factors among renal transplant recipients emphasizes the importance of taking appropriate therapeutic measures to reduce modifiable risk factors, reducing CVD and its consequences.