Cardiovascular disease after renal transplantation.

Abstract

Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P < 0.05). The RR of each acute rejection episode was 1.40 for ischemic heart disease and 1.24 for cerebral vascular disease. Among serum lipid levels, high-density lipoprotein cholesterol was the best predictor of ischemic heart disease (RR = 0.80 for each 10 mg/dL). Posttransplant ischemic heart disease was strongly predictive of cerebral (5.80) and peripheral vascular disease (5.22), whereas ischemic heart disease was predicted by posttransplant cerebral (8.25) and peripheral vascular disease (4.58). Other risk factors for vascular disease included age, gender, cigarette smoking, pretransplant splenectomy, and serum albumin. Hypertension and low-density lipoprotein cholesterol had no effect, perhaps because of aggressive pharmacologic treatment. Thus, the incidence of cardiovascular disease continues to be high after renal transplantation, and multiple risk factors suggest a number of possible strategies for more effective treatment and prevention.

New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients

“…Dyslipidemia is common among KTRs and is an important CVD risk factor. [39][40][41] In fact, most commonly used immunosuppressive drugs, that is, CNIs, corticosteroids, and mTOR inhibitors, can contribute to dyslipidemia in KTRs. 42…”

Managing cardiovascular disease risk in South Asian kidney transplant recipients

“…SA more likely transport an existing diabetes burden to their post-transplant phase. Pre-existing diabetes increases the risk of post-transplant CVD threefold[ 52 ]. Significant CAD is detectable by angiography in a third to half of diabetic patients with ESKD[ 53 ].…”

Isolated nocturnal hypertension in pediatric kidney transplant recipients

“…Arterial hypertension is a very common and serious complication in both adult and pediatric kidney transplant recipients 1–4 . It is an established risk factor for cardiovascular disease (CVD) morbidity and mortality as well as for impaired graft survival in transplanted patients 5–11 . Therefore, office blood pressure (OBP) must be measured during every outpatient visit of a transplanted child according to the recommendations of the 2017 American Academy of Pediatrics Clinical Practice Guidelines or the 2021 KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease 12,13 .…”

“…[1][2][3][4] It is an established risk factor for cardiovascular disease (CVD) morbidity and mortality as well as for impaired graft survival in transplanted patients. [5][6][7][8][9][10][11] Therefore, office blood pressure (OBP) must be measured during every outpatient visit of a transplanted child according to the recommendations of the 2017 American Academy of Pediatrics Clinical Practice Guidelines or the 2021 KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. 12,13 However, in the last two decades, it has become clear that 24-h ambulatory blood pressure monitoring (ABPM) is a better diagnostic tool for post-transplant hypertension compared to OBP because ABPM has the ability to detect white-coat hypertension, masked hypertension, and nocturnal hypertension, which are common phenomena among transplanted children.…”