Acute Coronary Syndromes after Renal Transplantation in Patients with End-Stage Renal Disease Resulting from Diabetes

Abstract

Coronary heart disease is the leading cause of death in both diabetes mellitus and end-stage renal disease. Although renal transplantation is known to reduce mortality in end-stage renal disease, its effect on the incidence of acute coronary syndromes is unknown. Using data from the United States Renal Data System, we studied 11 369 patients with endstage renal disease due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994 to 30 June 1997. Cox nonproportional hazards regression models were used to calculate the adjusted, time-dependent relative risk for the most recent hospitalization for acute coronary syndromes (including acute myocardial infarction, unstable angina, or other acute coronary syndromes, ICD9 Code 410.x or 411.x) for a given patient in the study period. Demographics and comorbidities were controlled by using data from the medical evidence form (HCFA 2728). After renal transplantation, patients had an incidence of acute coronary syndromes of 0.79% per patient year, compared to 1.67% per patient year prior to transplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for acute coronary syndromes (hazard ratio 0.38, 95% confidence interval, 0.30-0.49). Patients with end-stage renal disease due to diabetes on the renal transplant waiting list were much less likely to be hospitalized for acute coronary syndromes after renal transplantation. The reasons for this decreased risk should be the subject of further study. 274

Graft Loss and Acute Coronary Syndromes after Renal Transplantation in the United States

“…plant waiting list (0.38, the reciprocal of which is 2.63) (10). Because the present study was weighted toward recipients of living donor transplants, the impact of graft loss on ACS may be underestimated in the present study despite its use of comorbidity data.…”

“…Renal insufficiency has recently been identified as an independent risk factor for recurrent coronary artery disease in the general population (9). Improvement in renal function in patients with dialysis-dependent renal failure, such as occurs after renal transplantation in patients on the renal transplant waiting list, has been independently associated with a lower risk of hospitalized acute coronary syndromes (10).…”

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…Renal transplantation decreases the incidence of acute coronary syndrome compared with maintenance dialysis 73, 74, 75. Renal transplantation is also independently associated with a lower risk of acute coronary syndrome in patients with ESRD secondary to diabetes mellitus compared with patients maintained on hemodialysis 74.…”

Early Renal Insufficiency and Hospitalized Heart Disease after Renal Transplantation in the Era of Modern Immunosuppression

“…However, evidence from the general population indicates that renal insufficiency is a risk factor (either independently or because of its association with other risk factors) for all-cause death and particularly cardiovascular diseaserelated death (3,4). Patients who receive renal transplants may have a lower risk of ischemic heart disease, compared with comparable dialysis patients on the renal transplant waiting list (5) or patients who later experience renal allograft failure (6). However, studies have yielded conflicting results on whether posttransplantation renal insufficiency, which has been assessed by using different methodologies (7,8), is associated with an increased risk of nonfatal cardiovascular disease among renal transplant recipients.…”