CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Is There a Reversal of Reverse Epidemiology in Renal Transplant Recipients?

Associations between Advanced Glycation End Products, Body Composition and Mediterranean Diet Adherence in Kidney Transplant Recipients

There is limited evidence on the associations between dietary patterns, body composition, and nonclassical predictors of worse outcomes such as advanced glycation end products (AGE) in kidney transplant recipients (KTRs). The aim of this cross-sectional study was to determine the level of AGE-determined cardiovascular (CV) risk in Dalmatian KTRs and possible associations between AGE, adherence to the Mediterranean diet (MeDi), and nutritional status. Eighty-five (85) KTRs were enrolled in this study. For each study participant, data were collected on the level of AGE, as measured by skin autofluorescence (SAF), Mediterranean Diet Serving Score (MDSS), body mass composition, anthropometric parameters, and clinical and laboratory parameters. Only 11.76% of the participants were adherent to the MeDi. Sixty-nine percent (69%) of KTRs had severe CV risk based on AGE, while 31% of KTRs had mild to moderate CV risk. The results of the LASSO regression analysis showed that age, dialysis type, dialysis vintage, presence of CV and chronic kidney disease, C- reactive protein level, urate level, percentage of muscle mass, and adherence to recommendations for nuts, meat, and sweets were identified as positive predictors of AGE. The negative predictors for AGE were calcium, phosphate, cereal adherence according to the MeDi, and trunk fat mass. These results demonstrate extremely low adherence to the MeDi and high AGE levels related CV risk in Dalmatian KTRs. Lifestyle interventions in terms of CV risk management and adherence to the MeDi of KTRs should be taken into consideration when taking care of this patient population.

Cause of death with graft function among renal transplant recipients in an integrated healthcare system

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients with a functioning allograft. Modification of CVD risk factors may, therefore, decrease overall mortality in this patient population. We studied renal transplant recipients within an integrated healthcare system (IHS) that uses case management and electronic health records to determine mortality from CVD.

METHODS

We retrospectively collected data on all renal transplant recipients over a 10-year period. The primary endpoint was death with graft function (DWGF). Cardiovascular events were used as secondary endpoints. We determined the cause of death and collected laboratory data. The data were analyzed using Student's t test for continuous data, chi square for categorical data, and multivariate logistic regression. Survival was determined using the Kaplan-Meier product-limit method.

RESULTS

Death from "other" causes accounted for 29%. This was followed by CVD (24%), infection (16%), and malignancy (12%). The most common "other" causes were diabetes mellitus and end-stage renal disease. Overall, lower hemoglobin, uncontrolled blood pressure, and lower albumin levels were associated with DWGF. There were 184 cardiovascular events in total. Low-density lipid levels were lower in the group with cardiovascular events and DWGF. The use of antihypertensive and antihyperlipidemic agents was similar between the two groups with the exception of diuretics, which were used more often in the DWGF group.

CONCLUSIONS

There was a low rate of DWGF because of CVD within this IHS. It is possible that coordinated care within an IHS leads to improved cardiovascular mortality.

Coronary artery calcification and coronary ischaemia in renal transplant recipients

BACKGROUND

Cardiovascular disease is the leading cause of mortality among renal transplant recipients. Data on the relationship between coronary artery calcification (CAC) and coronary ischaemia in renal transplantation patients are scant. We conducted a study to determine the prevalence and determinants of CAC in these patients; we also examined the frequency of coronary ischaemia in patients with moderate and severe CAC.

METHODS

We used multi-detector spiral computed tomography to examine CAC in 178 consecutive renal transplant recipients. Angina pectoris was sought with the Rose questionnaire. The extent of calcification was measured by Agatston score. Myocardial perfusion scintigraphy was performed in patients with moderate and severe CAC. Multivariate logistic and linear regression analysis was used to evaluate the determinants of CAC presence and CAC score, respectively.

RESULTS

CAC was present in 72 patients (40.4%), mean CAC score was 113.7±275.5 (median: 0 and range: 0-1712). Age, time on transplantation and Rose angina pectoris were the independent determinants of both CAC presence and high CAC scores in all multivariate models. Coronary ischaemia was detected in 17.1% of the patients with moderate-to-severe CAC.

CONCLUSIONS

CAC is highly prevalent in renal transplant recipients; it is associated with symptoms of coronary ischaemia. Time on transplantation is an independent determinant of CAC. Future studies to evaluate the prognostic significance of CAC in these patients are necessary.

Malnutrition, inflammation, and lipids in a cohort of dialysis patients

BACKGROUND

This study aimed to determine if there is an association between lipid levels, serum albumin, and C-reactive protein (CRP) levels in patients on dialysis.

METHODS

Lipid profiles, albumin, and CRP levels were collected after a 12-hour fast from patients with end-stage renal disease (N = 105) who were on chronic hemodialysis. Patients were placed in an albumin group (>or= 3.8 g/dL) or a hypoalbumin group (< 3.8 g/dL), a high-risk CRP group (> 3 mg/dL) or a low-risk CRP group (<or= 3 mg/dL), and a low-risk group (low CRP and normal albumin) and high-risk group (high CRP and hypoalbumin). Lipid values included low-density lipoprotein (LDL), LDL particle number, LDL particle size, very-low-density lipoprotein (VLDL), large VLDL, high-density lipoprotein (HDL), large HDL, total cholesterol, lipoprotein A (Lp[a]), and triglycerides. All variables were measured using nuclear magnetic resonance spectroscopy.

RESULTS

Analysis of variance revealed significant differences in the hypoalbumin group, with LDL particle number being lower in this group. Analysis of variance revealed significant differences in LDL, VLDL, and LDL particle number, with lower levels in the high-risk CRP group. Analysis of variance also revealed significant differences in total cholesterol, VLDL, large VLDL, triglycerides, Lp(a), LDL, and LDL particle number when risk was combined with hypoalbumin and high CRP.

CONCLUSIONS

Our study found a counterintuitive effect in LDL and VLDL in patients with high CRP levels, in LDL particle number in patients with low albumin levels, and most variables when patients had both high CRP levels and low levels of albumin.