C-Reactive Protein and Body Mass Index Independently Predict Mortality in Kidney Transplant Recipients

Winkelmayer, Wolfgang C.; Lorenz, Matthias; Kramar, Reinhard; Födinger, Manuela; Hörl, Walter H.; Sunder‐Plassmann, Gere

doi:10.1111/j.1600-6143.2004.00477.x

Cited by 57 publications

(50 citation statements)

References 29 publications

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“…An elevated concentration of C-reactive protein (CRP) is independently associated with increased risk for CVD events in transplant recipients (63). This finding is consistent with studies in the general population demonstrating an association between CRP and ischemic heart disease.…”

Section: C-reactive Proteinsupporting

confidence: 79%

Cardiovascular Disease in Transplant Recipients

Gill¹

2008

Clinical Journal of the American Society of Nephrology

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A cardiovascular disease event in a transplant recipient may be the result of a pretransplantation disease process, a direct effect of immunosuppressant medications, or the result of exposure to a variety of traditional and nontraditional risk factors after transplantation. Although the understanding of posttransplantation cardiovascular disease remains incomplete, there is evidence that the impact of posttransplantation cardiovascular disease has been decreased, through increased attention to this problem. In the absence of controlled studies to guide therapy, this review summarizes treatment of cardiovascular disease risk factors for which there is strong evidence of benefit in the nontransplantation setting, observational evidence of a similar risk in transplant recipients, and evidence that treatment can be safely administered to transplant recipients. Putative risk factors for posttransplantation cardiovascular disease for which the current level of evidence is insufficient to support specific treatment recommendations are also discussed. Potential new strategies to decrease the risk for cardiovascular disease events after transplantation in the future, including aggressive pretransplantation risk reduction, individualized treatments to prevent different types of cardiovascular disease, dedicated efforts to reduce cardiovascular disease events during transitions between dialysis and transplantation, and manipulation of immunosuppressant protocols, are also introduced.Clin J Am Soc Nephrol 3: S29 -S37, 2008. doi: 10.2215/CJN.02690707A lthough increased awareness of cardiovascular disease (CVD) has resulted in a reduction in CVD-related deaths over time (1,2), CVD remains the major known cause of death in transplant recipients (3) and is a significant barrier to improving long-term outcomes in kidney transplantation. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, dyslipidemia) in this patient population; however, a significant portion of CVD risk in transplant recipients is unexplained by these factors (4) and may be related to pretransplantation exposure to chronic kidney disease (CKD)-related risk factors, ongoing exposure to CKD-related risk factors as a result of impaired allograft function, or to transplant-specific risk factors including those related to the use of immunosuppressant medications or infection. Given the relative absence of randomized, controlled trials in transplant recipients, this review summarizes treatments for which there is strong evidence of benefit in the nontransplantation setting, observational evidence of a similar risk in transplant recipients, and evidence that treatment can be safely administered to transplant recipients. The review also summarizes putative risk factors for posttransplantation CVD, for which the current level of evidence is insufficient to support specific treatment recommendations. Finally, the review introduces new strategies to decrease the risk for...

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Section: C-reactive Proteinsupporting

confidence: 79%

Cardiovascular Disease in Transplant Recipients

Gill¹

2008

Clinical Journal of the American Society of Nephrology

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“…By dichotomizing the CRP at 0.5 mg/dl, Winkelmayer et al showed that renal transplant patients above that level had a 53% increased mortality risk compared with patients with a CRP below the threshold (22). In a subsequent paper, Winkelmayer and colleagues demonstrated a J-shaped association between hsCRP and mortality in kidney transplant recipients when dividing hsCRP values into quartiles for values below 5 mg/L.…”

Section: Discussionmentioning

confidence: 91%

“…The IL-6 data are more difficult to assess across diverse populations because of lack of standardized methods (31). However, in the posttransplant recipients, the inflammatory markers CRP and IL-6 have been reported to be elevated in most studies on renal transplant recipients (19,(21)(22)(23)(32)(33)(34)(35)(36), although they are lower than pretransplant values (37).…”

Section: Discussionmentioning

confidence: 99%

“…Ducloux et al followed a small cohort of renal transplant patients and reported that elevated CRP predicted coronary events (21). In a prospective registrybased study, Winkelmayer and colleagues showed that kidney transplant patients with a CRP above 5 mg/dl had an increased mortality compared with patients below that threshold (22), and in a subsequent follow-up paper the authors demonstrated a J-shaped association between hsCRP (below 5 mg/L) and mortality (23). There are no reports of assessment of an association between hsCRP and/or IL-6 and major cardiovascular events or all-cause mortality in prospectively controlled trials in renal transplant patients.…”

mentioning

confidence: 99%

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Inflammation in Renal Transplantation

Abedini¹,

Holme²,

März³

et al. 2009

Clinical Journal of the American Society of Nephrology

105

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Background and objectives: Renal transplant recipients experience premature cardiovascular disease and death. The association of inflammation, all-cause mortality, and cardiovascular events in renal transplant recipients has not been examined in a large prospective controlled trial.Design, setting, participants, & measurements: ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin on cardiovascular and renal outcomes in 2102 renal transplant recipients. Patients initially randomized to fluvastatin or placebo in the 5-to 6-yr trial were offered open-label fluvastatin in a 2-yr extension to the original study. The association between inflammation markers, high-sensitivity C-reactive protein (hsCRP), and IL-6 on cardiovascular events and all-cause mortality was investigated.Results: The baseline IL-6 value was 2.9 ؎ 1.9 pg/ml (n ‫؍‬ 1751) and that of hsCRP was 3.8 ؎ 6.7 mg/L (n ‫؍‬ 1910). After adjustment for baseline values for established risk factors, the hazard ratios for a major cardiac event and all-cause mortality for IL-6 were 1.08 [95% confidence interval (CI), 1.01 to 1.15, P ‫؍‬ 0.018] and 1.11 (95% CI, 1.05 to 1.18, P < 0.001), respectively. The adjusted hazard ratio for hsCRP for a cardiovascular event was 1.10 (95% CI, 1.01 to 1.20, P ‫؍‬ 0.027) and for all-cause mortality was 1.15 (95% CI, 1.06 to 1.1.25, P ‫؍‬ 0.049).Conclusions: The inflammation markers IL-6 and hsCRP are independently associated with major cardiovascular events and all-cause mortality in renal transplant recipients.

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“…High-sensitivity C-reactive protein (hsCRP) has been found to be independently associated with major CV events and allcause mortality in RTRs [135,136] , although this is not supported unanimously by all studies [137] . Those with a CRP > 5 have an increased mortality compared to patients below that threshold [138] and there is a Jshaped association between hsCRP and mortality suggesting that RTRs with very low hsCRP may also be at increased risk of death [139] . More novel markers such as asymmetric dimethylarginine, which is associated with endothelial dysfunction, are also associated with higher risk of mortality (HR = 2.18) and developing CVD (HR = 2.59) in ESRD [140] .…”

Section: Inflammationmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

119

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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C-Reactive Protein and Body Mass Index Independently Predict Mortality in Kidney Transplant Recipients

Cited by 57 publications

References 29 publications

Cardiovascular Disease in Transplant Recipients

Cardiovascular Disease in Transplant Recipients

Inflammation in Renal Transplantation

Cardiovascular risk factors following renal transplant

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