Incidence of Cardiovascular Events in Renal Transplant Recipients and Clinical Relevance of Modifiable Variables

Valdés-Cañedo, Francisco; Pita-Fernández, Salvador; Seijo-Bestilleiro, Rocío; Pértega-Díaz, Sonia; Alonso-Hernández, Ángel; Cillero-Rego, S.; Fernández-Rivera, Constantino; Oliver-Garcia, J.

doi:10.1016/j.transproceed.2007.06.010

Cited by 14 publications

(15 citation statements)

References 6 publications

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“…An additional modifiable risk factor we identified was tobacco smoking, which was associated with a substantially increased risk of hospitalization. Prior studies have linked tobacco consumption posttransplant to negative cardiovascular and graft-related outcomes 25,26 , and our study suggests that pretransplant tobacco cessation remains an important goal for all patients.…”

Section: Discussionmentioning

confidence: 57%

Hospitalization Among Individuals Waitlisted For Kidney Transplant

et al. 2017

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Background For patients waitlisted for a deceased-donor kidney, hospitalization is associated with a lower likelihood of transplantation and worse posttransplant outcomes. However, individual-, neighborhood-, and regional-level risk factors for hospitalization throughout the waitlist period and specific causes of hospitalization in this population are unknown. Methods We used United States Renal Data System Medicare-linked data on patients waitlisted between 2005 and 2013 with continuous enrollment in Medicare Parts A & B (n=53 810) to examine the association between annual hospitalization rate and a variety of demographic, clinical, and social factors. We used multi-level multivariable ordinal logistic regression to estimate odds ratios (OR). Results Factors associated with significantly increased hospitalization rates among waitlisted individuals included older age, female sex, more years on dialysis prior to waitlisting, tobacco use, PRA>0, public insurance or no insurance at ESRD diagnosis, more regional acute care hospital beds, and urban residence (all p<0.05). Among patients’ dialysis-dependent when waitlisted, individuals with arteriovenous fistulas were significantly less likely than individuals with indwelling catheters or grafts to be hospitalized (OR=0.79 and 0.82, respectively, both p<0.001). The most common causes of hospitalization were complications related to devices, implants, and grafts; hypertension; and sepsis. Conclusion Individual- and regional-level variables were significantly associated with hospitalization while waitlisted, suggesting that personal, health-system, and geographic factors may impact patients’ risk. Conditions related to dialysis access and comorbidities were common hospitalization causes, underscoring the importance proper access management and care for additional chronic health conditions.

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Section: Discussionmentioning

confidence: 57%

Hospitalization Among Individuals Waitlisted For Kidney Transplant

et al. 2017

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“…Though the relatively smaller obese cohort in our study might explain the above difference, the 2 groups were demographically comparable. Valdés-Cañedo et al [34] have shown that advanced age, high BMI and decreased creatinine clearance at the time of transplantation were associated with an increased risk for adverse cardiovascular events 1 year after transplant. They also showed that a history of cardiovascular disease, low creatinine clearance 1 year after transplantation, posttransplantation hypertension, posttransplantation diabetes mellitus, smoking and increased left ventricular hypertrophy were associated with increased risk for adverse cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

et al. 2008

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Background: There is insufficient data on the impact of recipient body mass index (BMI) on the long-term graft survival of adult patients transplanted with single pediatric kidneys. Methods: We performed a retrospective analysis of adult patients transplanted with single pediatric kidneys at our center. The recipients were classified into 2 groups: group 1 (BMI ≥30) and group 2 (BMI <30). Donor/recipient demographics, postoperative outcomes and survival rates were compared between the 2 groups. Results: There was no significant difference in donor/recipient demographics between the 2 groups. In group 1, the death-censored graft survival (DCGS) at 1, 3 and 5 years was 90% at all 3 time points, and in group 2 it was 86, 68 and 60%, respectively (p = 0.05). The mean glomerular filtration rate (with standard deviation in parentheses) at 1, 3 and 5 years was, respectively, 55 (15), 59 (19) and 55 (28) ml/min for group 1, compared to 65 (28), 69 (23) and 67 (20) ml/min in group 2 (p = NS). Multivariate analysis revealed a hazard ratio of 5.12 (95% confidence interval 1.06–24.7; p = 0.04) for graft loss in nonobese patients when compared to obese patients. Obese patients had an increased risk for acute rejections within the first month of transplant (p = 0.02). Conclusion: Patients with a BMI ≥30 transplanted with single pediatric kidneys have better DCGS rates when compared to nonobese patients.

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“…We assumed that the incidence of cardiovascular complications at 5 years would be 22% [17]. With that assumption, the sample size will detect a relative risk of 1.46 or more by a risk factor with a prevalence of 50% at 5% alpha and 20% beta in an analysis using Cox regression model.…”

Section: Methodsmentioning

confidence: 99%

KNOW-KT (KoreaN cohort study for outcome in patients with kidney transplantation: a 9-year longitudinal cohort study): study rationale and methodology

et al. 2014

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BackgroundAsian patients undergoing kidney transplantation (KT) generally have better renal allograft survival and a lower burden of cardiovascular disease than those of other racial groups. The KNOW-KT aims to explore allograft survival rate, cardiovascular events, and metabolic profiles and to elucidate the risk factors in Korean KT patients.MethodsKNOW-KT is a multicenter, observational cohort study encompassing 8 transplant centers in the Republic of Korea. KNOW-KT will enroll 1,000 KT recipients between 2012 and 2015 and follow them up to 9 years. At the time of KT and at pre-specified intervals, clinical information, laboratory test results, and functional and imaging studies on cardiovascular disease and metabolic complications will be recorded. Comorbid status will be assessed by the age-adjusted Charlson co-morbidity index. Medication adherence and information on quality of life (QoL) will be monitored periodically. The QoL will be assessed by the Kidney Disease Quality of Life Short Form. Donors will include both living donors and deceased donors whose status will be assessed by the Kidney Donor Risk Index. Primary endpoints include graft loss and patient mortality. Secondary endpoints include renal functional deterioration (a decrease in eGFR to <30 mL/min/1.73 m2), acute rejection, cardiovascular event, albuminuria, new-onset diabetes after transplant, and QoL. Data on other adverse outcomes including episodes of infection, malignancy, recurrence of original renal disease, fracture, and hospitalization will also be collected. A bio-bank has been established for the acquisition of DNA, RNA, and protein from serum and urine samples of recipients at regular intervals. Bio-samples from donors will also be collected at the time of KT. KNOW-KT was registered in an international clinical trial registry (NCT02042963 at http://www.clinicaltrials.gov) on January 20th, 2014.ConclusionThe KNOW-KT, the first large-scale cohort study in Asian KT patients, is expected to represent the Asian KT population and provide information on their natural course, complications, and risk factors for complications.

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Incidence of Cardiovascular Events in Renal Transplant Recipients and Clinical Relevance of Modifiable Variables

Cited by 14 publications

References 6 publications

Hospitalization Among Individuals Waitlisted For Kidney Transplant

Hospitalization Among Individuals Waitlisted For Kidney Transplant

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

KNOW-KT (KoreaN cohort study for outcome in patients with kidney transplantation: a 9-year longitudinal cohort study): study rationale and methodology

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