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Singh BP, Jha VK, Khurana H, Mahapatra D, Shashibhusan. Improved Arterial Stiffness Indices 3 and 6 Months after Living-donor Renal Transplantation. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:378-388. [PMID: 38995296 DOI: 10.4103/1319-2442.397199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Arterial stiffness is a non-traditional risk factor of cardiovascular disease and may explain part of the excess cardiovascular risk in chronic kidney disease patients. Successful renal transplantation (RT) may restore renal function and improve several metabolic abnormalities involved in arterial stiffness. This prospective study conducted non-invasive assessments of arterial stiffness indices [the augmentation index (AI) and pulse wave velocity (PWV)] in end-stage kidney disease (ESKD) patients before RT and 3 and 6 months after living-donor RT, alongside the effects of age and calcineurin inhibitors on arterial stiffness. The study included 26 ESKD patients (22 males and 4 females; mean age, 34.07 years; median duration of dialysis, 10 months) scheduled for RT and followed up for three visits (within 1 week before transplantation, and 3 and 6 months after transplantation). Six months after successful RT, the patients had nearly normal serum creatinine and significantly improved serum phosphate and intact parathyroid hormone levels. The pretransplant AI was 21.53% ± 13.61% which reduced significantly 6 months after RT to 16.19% ± 10.74% (P <0.05). Although there was a reduction in PWV 6 months after RT from the pre-transplant PWV, it was not significant. A significant correlation between age and the augmentation index was noted 3 and 6 months after RT. Patients on tacrolimus-based immunosuppression after RT showed significant improvements in the AI compared with patients on a cyclosporine-based regimen. RT helped to improve arterial stiffness indices, resulting in reduced cardiovascular risk.
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Affiliation(s)
- Bhanu Pratap Singh
- Department of Radiology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Vijoy Kumar Jha
- Department of Nephrology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Harshit Khurana
- Department of Hematology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Debasish Mahapatra
- Department of Nephrology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Shashibhusan
- Department of Medicine, Indian Naval Hospital Ship Kalyani, Vizag, India
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Updated Pathways in Cardiorenal Continuum after Kidney Transplantation. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains one of the leading causes for increased morbidity and mortality in chronic kidney disease (CKD). Kidney transplantation is the preferred treatment option for CKD G5. Improved perioperative and postoperative care, personalized immunosuppressive regimes, and refined matching procedures of kidney transplants improves cardiovascular health in the early posttransplant period. However, the long-term burden of CVD is considerable. Previously underrecognized, the role of the complement system alongside innate immunity, inflammaging, structural changes in the glomerular filtration barrier and early vascular ageing also seem to play an important role in the posttransplant management. This review provides up-to-date knowledge on these pathways that may influence the cardiovascular and renal continuum and identifies potential targets for future therapies. Arterial destiffening strategies and the applicability of sodium-glucose cotransporter 2 inhibitors and their role in cardiovascular health after kidney transplantation are also addressed.
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Association between Long-Term Change in Arterial Stiffness and Cardiovascular Outcomes in Kidney Transplant Recipients: Insights from the TRANSARTE Study. J Clin Med 2022; 11:jcm11051410. [PMID: 35268501 PMCID: PMC8911013 DOI: 10.3390/jcm11051410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Increased arterial stiffness is associated with cardiovascular (CV) diseases in end-stage renal disease (ESRD) patients, and CV mortality remains higher in kidney transplantation (KT) recipients compared to in the general population. KT is associated with an improvement in arterial stiffness in the early post-transplant period, followed by a potential re-worsening in the late period. In a cohort of KT patients, we evaluated the associations of pulse-wave velocity (PWV) measured at different time-points (pre-transplant, and early and late post-transplant periods) with CV morbi-mortality, as well as the evolution between these measurements with CV morbi-mortality. (2) Methods: Forty KT recipients with a 10-year follow-up were included. The association of PWV with CV events was assessed with multivariable cox analysis. Backward linear regressions were conducted to identify the determinants of PWV at 1 year and those of the long-term evolution of PWV after KT (delta PWV at 1 year—latest PWV). (3) Results: The absence of arterial stiffening during the long-term follow-up after KT is associated with a lower CV outcome rate (HR for the delta PWV = 0.76 (0.58−0.98), p = 0.036). Age at KT is associated with the worsening of arterial stiffness in the late post-transplantation period (β for the delta PWV = −0.104, p = 0.031). A high PWV at 1 year was associated with a potential for recovery during follow-up (β = 0.744, p < 0.0001). (4) Conclusions: The absence of PWV worsening in the late post-transplantation period was significantly associated with a lower risk of CV events, whereas early changes in PWV were not. Finding an intervention capable of reducing long-term PWV could improve the prognosis of KT recipients.
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Alatič J, Lindič J, Godnov U, Kovač D. Arterial Stiffness in Renal Transplant Recipients: 5-Year Follow-up. Transplant Proc 2021; 53:2907-2912. [PMID: 34772493 DOI: 10.1016/j.transproceed.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic kidney disease is a risk factor for cardiovascular diseases. After renal transplant, some traditional and chronic kidney disease-specific risk factors vanish, but new risk factors emerge. This retrospective study aimed to define the long-term impact of renal transplant and diabetes mellitus on arterial stiffness, evaluated by measuring pulse wave velocity (PWV) and augmentation index (AI) and on myocardial perfusion, evaluated by subendocardial viability ratio (SEVR). METHODS PWV, AI, and SEVR were evaluated noninvasively by applanation tonometry using SphygmoCor in the first 4 weeks after kidney transplant and 4 to 5 years thereafter. RESULTS A total of 48 graft recipients (18 women, 30 men; mean ± standard deviation age, 47.9 ± 11.8 years) were included. The follow-up period was 57.4 ± 8.0 months. PWV did not change significantly during the follow-up period (9.1 ± 1.8m/s and 8.7 ± 1.8m/s, respectively; P = .137). In the subgroup of patients without diabetes mellitus, we observed a trend of PWV reduction, whereas in the subgroup of patients with diabetes we observed the trend of PWV increase. The duration of smoking before transplant correlated significantly with PWV (P = .012). AI in the whole group increased significantly during the study period (from 18.3% ±10.3% to 25.9% ±9.4%; P < .01) as well as SEVR (from 134.9 ± 23.1 to 155.4 ± 28.6; P = .001). CONCLUSIONS PWV, reflecting the central vessel stiffness, did not change significantly in the whole group during the follow-up period. The AI, which indicates systemic stiffness, increased significantly within 5 years after transplant, indicating the progression of vascular processes of elastic and muscular arteries. Significant increases in the SEVR values in both diabetics and nondiabetics indicate the long-term favorable effect of kidney transplant on myocardial perfusion.
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Affiliation(s)
- Jan Alatič
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Jelka Lindič
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Uroš Godnov
- Department of Computer Science, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Damjan Kovač
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia.
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Stocklassa T, Borchert-Mörlins B, Memaran N, Einecke G, Schmitt R, Richter N, Vondran FW, Bauer E, Markefke S, Melk A, Schmidt BMW. Sex Differences in Subclinical Cardiovascular Organ Damage After Renal Transplantation: A Single-Center Cohort Study. J Womens Health (Larchmt) 2020; 30:1352-1361. [PMID: 33211603 DOI: 10.1089/jwh.2020.8594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death after renal transplantation (RT). Sex-specific differences in CVD in the general population are well known. The aim of this study was to evaluate sex-specific differences in prevalence and course of subclinical cardiovascular (CV) organ damage in RT recipients during the first year after RT. Methods: In a prospective longitudinal study, we enrolled 121 patients (male 64%, age 51 ± 15 years). CV risk factors, left ventricular mass index (LVMI), and pulse wave velocity (PWV) were assessed at time of RT and 1 year later. Results: Women showed less prediagnosed CVD and better blood pressure (BP) control, and were less likely to be treated with calcium channel blockers (CCBs). Despite similar transplant function, LVMI increased in women and decreased in men (p = 0.027). In multivariable analysis, changes in LVMI were independently associated with female sex and systolic BP. Importantly, women receiving CCBs showed a decrease in LVMI and PWV. Conclusions: Our findings indicate a sex-specific association between RT and changes in LVMI. CCBs seem to have a positive impact on CV risk after RT, especially in women. Further studies on the effect of sex and CCB use in RT recipients are warranted.
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Affiliation(s)
- Tabea Stocklassa
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Bianca Borchert-Mörlins
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Gunilla Einecke
- Department of Nephrology and Hypertension, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Roland Schmitt
- Department of Nephrology and Hypertension, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Florian Wr Vondran
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Bauer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Sabrina Markefke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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6
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Junarta J, Hojs N, Ramphul R, Lowe-Jones R, Kaski JC, Banerjee D. Progression of endothelial dysfunction, atherosclerosis, and arterial stiffness in stable kidney transplant patients: a pilot study. BMC Cardiovasc Disord 2020; 20:6. [PMID: 31914943 PMCID: PMC6947963 DOI: 10.1186/s12872-019-01309-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background Kidney transplant patients suffer from vascular abnormalities and high cardiovascular event rates, despite initial improvements post-transplantation. The nature of the progression of vascular abnormalities in the longer term is unknown. This pilot study investigated changes in vascular abnormalities over time in stable kidney transplant patients long after transplantation. Methods Brachial artery flow-mediated dilation (FMD), nitroglycerin-mediated dilation, carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial pressure index, and common carotid artery intima-media thickness (CCA-IMT) were assessed in 18 kidney transplant patients and 17 controls at baseline and 3–6 months after. Results There was no difference in age (51 ± 13 vs. 46 ± 11; P = 0.19), body mass index (26 ± 5 vs. 25 ± 3; P = 0.49), serum cholesterol (4.54 ± 0.96 vs. 5.14 ± 1.13; P = 0.10), systolic blood pressure (BP) (132 ± 12 vs. 126 ± 12; P = 0.13), diastolic BP (82 ± 9 vs. 77 ± 8; P = 0.10), or diabetes status (3 vs. 0; P = 0.08) between transplant patients and controls. No difference existed in vascular markers between patients and controls at baseline. In transplant patients, FMD decreased (− 1.52 ± 2.74; P = 0.03), cf-PWV increased (0.62 ± 1.06; P = 0.03), and CCA-IMT increased (0.35 ± 0.53; P = 0.02). No changes were observed in controls. Conclusion Markers of vascular structure and function worsen in the post-transplant period on long-term follow-up, which may explain the continued high cardiovascular event rates in this population.
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Affiliation(s)
- Joey Junarta
- Renal and Transplantation Unit, St George's University Hospitals, NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Nina Hojs
- Renal and Transplantation Unit, St George's University Hospitals, NHS Foundation Trust, London, UK
| | - Robin Ramphul
- Renal and Transplantation Unit, St George's University Hospitals, NHS Foundation Trust, London, UK
| | - Racquel Lowe-Jones
- Renal and Transplantation Unit, St George's University Hospitals, NHS Foundation Trust, London, UK
| | - Juan C Kaski
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals, NHS Foundation Trust, London, UK. .,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
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Rodriguez RA, Hae R, Spence M, Shea B, Agharazii M, Burns KD. A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease. Kidney Int Rep 2019; 4:1109-1121. [PMID: 31440701 PMCID: PMC6698308 DOI: 10.1016/j.ekir.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk. We conducted a systematic review and meta-analysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events. Methods MEDLINE, EMBASE, and EBM databases were searched. Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers. Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models. Results A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included. Four intervention-comparator pairs were meta-analyzed. Quality of evidence ranged from very low to moderate. Kidney transplantation decreased cf-PWV (−0.70 m/s; CI: –1.3 to −0.11; P = 0.02) and SBP (−8.3 mm Hg; CI: −13.2 to −3.3; P < 0.001) over pretransplantation. In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (−1.90 m/s; CI: −3.3 to −0.5); P = 0.02) and SBP (−4.3 mm Hg; CI: −7.7 to −0.93); P = 0.01) compared with clinical assessment alone. Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia (P ≤ 0.01). Low calcium dialysate decreased cf-PWV (−1.70 m/s; CI: −2.4 to −1.0; P < 0.00001) without affecting SBP (−1.6 mm Hg; CI: −8.9 to 5.8; P = 0.61). Intradialytic exercise compared with no exercise reduced cf-PWV (−1.13 m/s; CI: −2.2 to −0.03; P = 0.04), but not SBP (+0.5 mm Hg; CI: −9.5 to 10.4); P = 0.93). Conclusions Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD. The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Spence
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Kevin D Burns
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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8
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Li Z, Qin Y, Du L, Luo X. An improvement of carotid intima-media thickness and pulse wave velocity in renal transplant recipients. BMC Med Imaging 2018; 18:23. [PMID: 30119645 PMCID: PMC6098595 DOI: 10.1186/s12880-018-0263-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 07/26/2018] [Indexed: 02/03/2023] Open
Abstract
Background Renal transplantation can significantly improve the quality of life of patients with end stage renal disease (ESRD) who would otherwise require dialysis. Renal transplant (RT) recipients have higher risks of cardiovascular disease compared with general population. The carotid intima-media thickness (CIMT) and pulse wave velocity (PWV) have been used as the important predicting factor of vascular arteriosclerosis. Therefore, this study was to investigate the improvement of carotid intima-media thickness and pulse wave velocity in renal transplant recipients. Methods Thirty-one patients with chronic kidney disease being treated with hemodialysis, 31 renal transplant recipients and 84 healthy control subjects were included to have the clinical evaluations and ultrasonography of bilateral carotid arteries. CIMT and PWV were independently measured by two ultrasonographers using the technique of ultrasonic radiofrequency tracking and correlated with arteriosclerosis risk factors. The progression of CIMT and PWV with age were analyzed by linear regression models, and the slopes of curves were compared using Z test. Results Compared with the patients on hemodialysis, the CIMT was significantly lower in renal transplant recipients and healthy control. The PWV were higher in hemodialysis patients and renal transplant recipients than that of the subjects in control group. The progression is CIMT positively corelated with age and cumulative duration in renal transplant recipients and hemodialysis patients. In both hemodialysis patients and renal transplant recipients, age and cumulative time on dialysis were all positively correlated with the increase of PWV as well. Conclusions Carotid intima-media thickness and pulse wave velocity is the predicting factors of developing arteriosclerosis, which were improved in renal transplant recipients. Electronic supplementary material The online version of this article (10.1186/s12880-018-0263-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhaojun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No.100 Hai Ning Road, Hongkou District, Shanghai, 200080, China
| | - Yan Qin
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No.100 Hai Ning Road, Hongkou District, Shanghai, 200080, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No.100 Hai Ning Road, Hongkou District, Shanghai, 200080, China
| | - Xianghong Luo
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No.100 Hai Ning Road, Hongkou District, Shanghai, 200080, China.
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9
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Laucyte-Cibulskiene A, Boreikaite E, Aucina G, Gudynaite M, Rudminiene I, Anisko S, Vareikiene L, Gumbys L, Valanciene D, Ryliskyte L, Strupas K, Rimsevicius L, Miglinas M. Usefulness of pretransplant aortic arch calcification evaluation for kidney transplant outcome prediction in one year follow-up. Ren Fail 2018; 40:201-208. [PMID: 29619867 PMCID: PMC6014335 DOI: 10.1080/0886022x.2018.1455588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR1year correlated with eGFRdischarge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFRdischarge (R-squared 0.65, p = .002) better predict eGFR1year than AoAC combined with recipient eGFRdischarge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFRdischarge could be related to kidney function in one-year follow-up.
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Affiliation(s)
- Agne Laucyte-Cibulskiene
- a Clinic of Gastroneterology, Nephrourology and Abdominal Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | | | - Gediminas Aucina
- b Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Migle Gudynaite
- c Centre of Nephrology, Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Ilona Rudminiene
- c Centre of Nephrology, Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Sigita Anisko
- c Centre of Nephrology, Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Loreta Vareikiene
- c Centre of Nephrology, Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Liutauras Gumbys
- d Centre of Radiology and Nuclear Medicine , Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Dileta Valanciene
- b Faculty of Medicine , Vilnius University , Vilnius , Lithuania.,d Centre of Radiology and Nuclear Medicine , Vilnius University Hospital Santaros Clinics , Vilnius , Lithuania
| | - Ligita Ryliskyte
- b Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Kestutis Strupas
- a Clinic of Gastroneterology, Nephrourology and Abdominal Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Laurynas Rimsevicius
- a Clinic of Gastroneterology, Nephrourology and Abdominal Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Marius Miglinas
- a Clinic of Gastroneterology, Nephrourology and Abdominal Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
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10
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Sidibé A, Fortier C, Desjardins MP, Zomahoun HTV, Boutin A, Mac-Way F, De Serres S, Agharazii M. Reduction of Arterial Stiffness After Kidney Transplantation: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.117.007235. [PMID: 29269351 PMCID: PMC5779037 DOI: 10.1161/jaha.117.007235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background End‐stage kidney disease is associated with increased arterial stiffness. Although correction of uremia by kidney transplantation (KTx) could improve arterial stiffness, results from clinical studies are unclear partly due to small sample sizes. Method and Results We conducted a systematic review and meta‐analysis of before‐after design studies performed in adult KTx patients with available measures of arterial stiffness parameters (pulse wave velocity [PWV], central pulse pressure [PP], and augmentation index) before and at any time post‐KTx. Mean difference of post‐ and pre‐KTx values of different outcomes were estimated using a random effect model with 95% confidence interval. To deal with repetition of measurement within a study, only 1 period of measurement was considered per study by analysis. Twelve studies were included in meta‐analysis, where a significant decrease of overall PWV by 1.20 m/s (95% CI 0.67‐1.73, I2=72%), central PWV by 1.20 m/s (95% CI 0.16‐2.25, I2=83%), peripheral PWV by 1.17 m/s (95% CI 0.17‐2.17, I2=79%), and brachial‐ankle PWV by 1.21 m/s (95% CI 0.66‐1.75, I2=0%) was observed. Central PP (reported in 4 studies) decreased by 4.75 mm Hg (95% CI 0.78–10.28, I2=50%). Augmentation index (reported in 7 studies) decreased by 10.5% (95% CI 6.9‐14.1, I2=64%). A meta‐regression analysis showed that the timing of assessment post‐KTx was the major source of the residual variance. Conclusions This meta‐analysis suggests a reduction of the overall arterial stiffness in patients with end‐stage kidney disease after KTx.
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Affiliation(s)
- Aboubacar Sidibé
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Hervé Tchala Vignon Zomahoun
- CHU de Québec Research Center, Université Laval Saint François d'Assise Hospital, Québec, Canada.,Quebec SPOR-SUPPORT Unit, Montreal, Québec, Canada
| | - Amélie Boutin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Sacha De Serres
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada .,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
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11
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Zapolski T, Furmaga J, Jaroszyński A, Wysocka A, Rudzki S, Wysokiński AP. The reverse remodeling of the aorta in patients after renal transplantation - the value of aortic stiffness index: prospective echocardiographic study. BMC Nephrol 2017; 18:33. [PMID: 28114900 PMCID: PMC5260005 DOI: 10.1186/s12882-017-0453-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/16/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Atherosclerosis is regarded as a combination of two major separate diseases: atherosis and sclerosis. Sclerotic component depends on deterioration of elastic properties of the aortic wall and is called aortic stiffness. The most valuable, non-invasive method of aortic stiffness assessment is echocardiography, which allows to calculate the aortic stiffness index (ASI). ASI is an independent predictor of all-cause and cardiovascular mortality in different groups of patients. The main aim of study was the assessment of the aortic reverse remodeling in patients with end-stage renal disease (ESRD) after renal transplantation (RT). METHODS Study group involved 42 patients aged 43.3 ± 12.6 years, including 19 women aged 49.9 ± 10.9 years and 23 men aged 41.5 ± 12.91 years, who have undergone RT from non-related renal transplant donors, The study protocol has been consisted of 5 stages: 1 week after RT, 3 months after RT, 6 months after RT, 1 year after RT and 3 years after RT. The echocardiographic examination was performed and measurements of Aomax, Aomin were done. On the base of obtained parameters ASI, aortic distensibility (AD) and aortic strain (AS) were calculated according to adequate formulas. RESULTS The improvement of indices characterizing the elastic properties of aorta were noted. These changes attained the statistically significant level only at the end of the observation. ASI just after RT was equal - 4.65 ± 1.58, three months after RT - 4.54 ± 1.49, six months after RT - 4.59 ± 1.61, one year after RT - 4.35 ± 1.21 and three years after RT - 3.35 ± 1.29, while AD reached respectively - 6.55 ± 3.76 cm2/dyn-110-6 just after RT, - 6.38 ± 3.42 cm2/dyn-110-6 three months after RT, - 6.53 ± 3.60 cm2/dyn-110-6 six months after RT, - 6.48 ± 2.79 cm2/dyn-110-6 one year after RT and - 8.03 ± 3.95 cm2/dyn-110-6 three years after RT. Noted AS values were equal - 6.61 ± 4.05%, just after RT, - 6.40 ± 3.58% three months after RT, - 6.56 ± 3.76%, six months after RT, - 6.45 ± 2.80% one year after RT, - 8.01 ± 3.97%. and three years after RT. The exact analysis of parameters concerning aortic function showed that to achieve ASI, AD and AS improvement, long time was needed, because the most significant changes of these indices were observed only between 1 year and 3 years after RT. CONCLUSIONS There is a relationship between renal transplantation and improvement of the aortic elastic properties. The recovery of the renal function allows to initiate the reparative processes leading to at least partial restitution of the structure and features of the aorta, which is called reverse remodelling. Improvement of aortic wall elastic properties after renal transplantation is a continuous and prolonged process.
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Affiliation(s)
- Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| | - Jacek Furmaga
- Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jaroszyński
- Department of Family Medicine, Medical University of Lublin, Lublin, Poland.,Department of Nephrology, Jan Kochanowski University in Kielce, Kielce, Poland.,Department of Family Medicine and Geriatrics, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Anna Wysocka
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.,Internal Medicine in Nursing Department, Medical University of Lublin, Lublin, Poland
| | - Sławomir Rudzki
- Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, Lublin, Poland
| | - Andrzej P Wysokiński
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
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12
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Kim HS, Seung J, Lee JH, Chung BH, Yang CW. Clinical Significance of Pre-Transplant Arterial Stiffness and the Impact of Kidney Transplantation on Arterial Stiffness. PLoS One 2015; 10:e0139138. [PMID: 26406607 PMCID: PMC4583424 DOI: 10.1371/journal.pone.0139138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background Arterial stiffness is closely associated with cardiovascular disease (CVD) in end stage renal disease (ESRD) patients. However, the clinical significance of pre-transplant arterial stiffness and the impact of kidney transplantation (KT) on arterial stiffness have not yet been determined. Method We measured the brachial-ankle pulse wave velocity (baPWV) before KT and one year after KT. We evaluated the potential utility of pre-transplant baPWV as a screening test to predict CVD. The impact of KT on progression of arterial stiffness was evaluated according to changes in baPWV after KT. The factors that influence the change of baPWV after KT were also examined. Result The mean value of pre-transplant baPWV was 1508 ± 300 cm/s in ESRD patients; 93.4% had a higher baPWV value than healthy controls. Pre-transplant baPWV was higher in patients with CVD than in those without CVD (1800 ± 440 vs. 1491 ± 265 cm/s, p<0.05), and was a strong predictive factor of CVD (OR 1.003, p<0.05). The optimal cut-off value of baPWV for the detection of CVD was 1591 cm/s, and this value was an independent predictor of CVD in KT recipients (OR 6.3, p<0.05). The post-transplant baPWV was significantly decreased compared to that of pre-transplant rates (1418 ± 235 vs. 1517 ± 293 cm/s, p<0.05), and progression of arterial stiffness was not observed in 86.9% patients. Logistic regression analysis revealed that higher body mass index and the degree of increase in calcium levels were independent risk factors that affected baPWV after KT. Conclusions Evaluation of arterial stiffness with baPWV is a useful screening test for predicting CVD after KT, and KT is effective in preventing the progression of arterial stiffness in ESRD patients.
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Affiliation(s)
- Hyun Seon Kim
- Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaeho Seung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hyun Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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13
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Birdwell KA, Jaffe G, Bian A, Wu P, Ikizler TA. Assessment of arterial stiffness using pulse wave velocity in tacrolimus users the first year post kidney transplantation: a prospective cohort study. BMC Nephrol 2015; 16:93. [PMID: 26133166 PMCID: PMC4489361 DOI: 10.1186/s12882-015-0092-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/23/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The leading cause of death in end stage renal disease is cardiovascular disease (CVD). Kidney transplantation is associated with improved survival over dialysis. We hypothesized that arterial stiffness, a marker of CVD, would improve in patients post kidney transplant, potentially explaining one mechanism of survival benefit from transplant. METHODS After obtaining Institutional Review Board approval and informed consent, we performed a longitudinal prospective cohort study of 66 newly transplanted adult kidney transplant recipients, using aortic pulse wave velocity (PWV) to assess arterial stiffness over a 12 month period. All patients were assessed within one month of transplant (baseline) and 12 months post transplant. The primary outcome was change in PWV score at 12 months which we assessed using Wilcoxon Signed Rank test. Secondary analyses included correlation of predictors with PWV score at both time points. RESULTS The median age of the cohort was 49.7 years at transplant, with 27 % Black and 27 % female. At baseline, 43 % had tobacco use, 30 % had a history of CVD, and 42 % had diabetes. Median baseline calcium was 9.1 mg/dL and median phosphorus was 5.1 mg/dL. Median PWV score was 9.25 and 8.97 m/s at baseline versus month 12, respectively, showing no significant change (median change of -0.07, p = 0.7). In multivariable regression, subjects with increased age at transplant (p = 0.008), diabetes (p = 0.002), and a higher baseline PWV score (p < 0.001) were at increased risk of having a high PWV score 12 months post transplant. CONCLUSION Aortic arterial stiffness does not progress in the first year post kidney transplant. Increasing age, diabetes, and higher baseline PWV score identify patients at risk for increased arterial stiffness. Further research that assesses patients for greater than one year and includes a control dialysis group would be helpful in further understanding the change in arterial stiffness post transplantation.
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Affiliation(s)
- Kelly Ann Birdwell
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA.
| | - Gilad Jaffe
- University at Buffalo School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY, 14260, USA.
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA.
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA.
| | - Talat Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA.
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14
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Claes KJ, Heye S, Bammens B, Kuypers DR, Meijers B, Naesens M, Vanrenterghem Y, Evenepoel P. Aortic calcifications and arterial stiffness as predictors of cardiovascular events in incident renal transplant recipients. Transpl Int 2013; 26:973-81. [PMID: 23870026 DOI: 10.1111/tri.12151] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/02/2012] [Accepted: 06/23/2013] [Indexed: 12/14/2022]
Abstract
Renal transplant recipients have an increased risk of cardiovascular (CV) disease. Arterial stiffness (AS) and aortic calcifications (ACs) are well-known CV risk factors in patients with chronic kidney disease. We aimed to determine the prognostic value of AS and AC in incident renal transplant recipients (RTRs). We conducted a prospective study in 253 single RTR. AC were scored by means of lumbar X-ray. Carotid-femoral pulse wave velocity (PWV) was assessed in a subgroup of 115 patients. AC were present in 61% of patients. After a mean follow-up of 36 months, 32 CV events occurred in the overall group and 13 events in the PWV subgroup. When we accounted for age, gender, and CV history, AC score (HR, hazard ratio 1.09 per 1 unit increase; 95% CI 1.02-1.17) and PWV (HR 1.45 per 1 m/s; 95% CI 1.16-1.8) remained an independent predictor of CV events in Cox-regression analyses. Using receiver operating characteristics, the area under the curve for predicting CV events amounted to 0.80 and 0.72 for sum AC and PWV, respectively. Both AS and AC are strong predictors of future CV events in an incident RTR population. These vascular assessments are readily available and easy to perform, making them ideal tools for further risk stratification. (ClinicalTrials.gov number: NCT00547040).
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Affiliation(s)
- Kathleen J Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, KU Leuven, Belgium
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15
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Gungor O, Kircelli F, Voroneanu L, Covic A, Ok E. Hormones and Arterial Stiffness in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2013; 20:698-707. [DOI: 10.5551/jat.18580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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16
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Chronic kidney disease and vascular remodelling: molecular mechanisms and clinical implications. Clin Sci (Lond) 2012; 123:399-416. [PMID: 22671427 DOI: 10.1042/cs20120074] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CKD (chronic kidney disease) is a severe and complex disease with a very high prevalence of CV (cardiovascular) complications. CKD patients are exposed to haemodynamic disturbances in addition to severe metabolic abnormalities that lead to a specific form of arterial remodelling, which contributes to the development of CV disease. Arterial calcification is a major event in the arterial remodelling process and is strongly linked to mineral metabolism abnormalities associated with CKD. Arterial remodelling is not limited to arterial calcification and modifications in arterial wall composition are also observed. Activation of the RAS (renin-angiotensin system), ET-1 (endothelin-1), endothelial dysfunction, oxidative stress and ADMA (asymmetric ω-NG,NG-dimethylarginine), as well as the anti-aging molecule Klotho, are implicated in this process. The present review details the mechanisms involved in arterial calcification and arterial remodelling associated with CKD, and provides the clinical consequences of large and small artery stiffness and remodelling in CKD patients.
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Hotta K, Harada H, Sasaki H, Iwami D, Fukuzawa N, Morita K, Seki T, Togashi M, Nonomura K. Successful kidney transplantation ameliorates arterial stiffness in end-stage renal disease patients. Transplant Proc 2012; 44:684-6. [PMID: 22483468 DOI: 10.1016/j.transproceed.2011.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Successful kidney transplantation (KTx) can ameliorate bodily damage caused by end-stage renal disease (ESRD). Arterial stiffness (AS) is one of the critical factors that shorten the survival of patients due to cardiovascular events. KTx may reduce AS as well; however, this has not been investigated well. We therefore conducted a retrospective study using noninvasive pulse wave velocity (PWV), which is a useful index of aortic damage. PATIENTS AND METHODS Fifty-eight consecutive kidney recipients (34 men, 24 women) were enrolled in this study. Mean age at transplantation was 40.5 ± 12.3 years and the dialysis period was 73.1 ± 95.8 months. The brachial-ankle PWV was measured preoperatively and 6 months postoperatively. First, we investigated the relationship between the PWV and the other parameters related to AS. Second, we studied the pre- to posttransplant change in PWV to evaluate the amelioration of AS after successful KTx. RESULTS PWV showed significant positive correlations with age, systolic blood pressure (BP), diastolic BP, and abdominal aortic calcification index. After successful KTx, PWV significantly decreased (P < .01). In addition, systolic and diastolic BP significantly decreased (P < .01 and P < .05, respectively). CONCLUSION Successful KTx ameliorates AS in ESRD patients. This might explain the improved cardiovascular prognosis of ESRD patients who undergo KTx.
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Affiliation(s)
- K Hotta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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