Long-Term Progression of Coronary Artery Calcification Is Independent of Classical Risk Factors, C-Reactive Protein, and Parathyroid Hormone in Renal Transplant Patients

Abstract

Aims: Compared to the general population, mortality is significantly increased in renal transplant recipients. In the general population, coronary artery calcification (CAC) and its evolution over time are associated with cardiovascular and all-cause mortality, and the study of this biomarker could provide useful information for describing the long-term progression of coronary heart disease in renal transplant recipients. Methods: We followed up a cohort of 113 renal transplant patients by performing three multi-detector computed tomography studies over 83.6 ± 6.8 months. Data analysis was performed by logistic regression analysis and by mixed linear modelling. Results: Progression was observed in 34.5% of patients. Baseline CAC and time-to-transplantation were the sole variables that predicted CAC evolution over time. Neither classical nor nontraditional risk factors, biomarkers of renal function (GFR) and kidney damage (albuminuria) or biomarkers of bone mineral disorder (BMD), such as serum phosphorus, calcium, and PTH, were associated with the long-term progression of coronary calcification. Serum triglycerides predicted CAC progression only in logistic regression analysis, while in addition to baseline CAC, time to transplantation was the sole variable predicting CAC progression when the data were analyzed by mixed linear modelling. These data suggested that, in addition to the background calcification burden, other unmeasured factors play major roles in promoting the evolution of coronary calcification in the transplant population. Conclusion: CAC progression continued over the long-term follow-up of renal transplant patients. This phenomenon was unaccounted for by classical and nontraditional risk factors, as well as by biomarkers of renal dysfunction and renal damage.

Coronary artery calcification progression and long-term cardiovascular outcomes in renal transplant recipients: an analysis by the joint model

“…The cohort of this study is formed by 178 consecutive, adult (≥18 years of age) renal transplantation recipients who participated in a study (March 2006 and December 2007) testing the relationship between the CAC score and coronary ischaemia [ 10 ]. We also examined the CAC progression in two consecutive follow-up studies [ 11 , 12 ]. The scope of the previous follow-up studies was that of estimating the risk for de novo CAC in patients without coronary artery disease at baseline.…”

“…Indeed, these studies provide information about individual changes in the variables of interest, exclude between-subject variations from error and allow investigation of the relationship between predictor variables with relevant study endpoints [ 43 ]. Several longitudinal studies in renal transplant patients [ 11 , 12 , 44–50 ], including one by us [ 12 ], focused on the progression of CAC after renal transplantation. The results of these longitudinal studies are disparate.…”

“…The results of these longitudinal studies are disparate. Indeed, some of these showed a slowing of the process starting 6 months after transplantation [ 44 ] or a global slowing [ 45 ], while the majority of long-term studies documented an unrelented progression of CAC [ 11 , 12 , 46–50 ]. However, in none of these studies was the relationship between CAC progression and death and cardiovascular events investigated.…”

Lipopolysaccharide-based endotoxemia produce toxicity in peripheral organs and microglia migration in a dose-dependent manner in rat substantia nigra

“…Another variable analysed was CRP content in serum. CRP is an acute phase protein of the inflammatory process expressed in response to non-specific stimuli like atherosclerosis, ischemia, necrosis, and vascular injury [15]. Its activation has been reported [33].…”

Vitamin K1 and K2 in the Diet of Patients in the Long Term after Kidney Transplantation

“…Cardiovascular (CV) diseases and bone disorders (next to malignancies and infections) are the most common complications in kidney transplant (KTx) recipients [ 1 , 2 , 3 , 4 ]. Vitamin K is considered to play a protective role in both the CV and skeletal systems [ 5 , 6 , 7 ].…”