Incidence of cardiovascular events and associated risk factors in kidney transplant patients: a competing risks survival analysis

Abstract

BackgroundThe high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients.MethodsAn observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981–2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events.Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390–459, except: 427.5, 435, 446, 459.0).ResultsThe mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes.ConclusionsThis study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events.

Genetic markers associated with long-term cardiovascular outcome in kidney transplant recipients

“…Traditional modifiable CV risk factors performed poorly in predicting cardiac events in the PORT study, a large scale clinical database consisting of 23 575RTRs 35. Similar findings were reported in a recent observational study of 2029 RTRs, applying competing risk survival analysis 36. Similar findings were reported in a recent observational study of 2029 RTRs, applying competing risk survival analysis 36.…”

“…Similar findings were reported in a recent observational study of 2029 RTRs, applying competing risk survival analysis. 36 The relevance of nonclassical CV risk factors is also illustrated in the current study, where risk factors specific to the transplant population: graft function, total time in renal replacement therapy, and total number of transplantations, were significantly associated with time to first MACE and included in multivariate analyses.…”

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

“…Recent years have seen the development and validation of several prognostic indices for mortality and comorbidity (mainly IHD) in KT recipients [12, 32, 40, 55, 63, 94, 107-128] (Table 5) and several e-resources (e.g. www.transplantscore.com, www.transplantmodels.…”

High-Density Lipoprotein Particles and Their Relationship to Posttransplantation Diabetes Mellitus in Renal Transplant Recipients

“…Posttransplantation diabetes mellitus (PTDM) is one of the major complications following renal transplantation. PTDM may be associated with adverse effects on both short-and long-term outcomes in renal transplant recipients (RTRs), including graft failure, cardiovascular disease, and patient survival [1][2][3][4]. The reported incidence of PTDM varies from 7% to 39% at one year after transplantation and from 10% to 30% at 3 years post-transplantation [5].…”