The Impact of Living Donor Kidney Transplantation on Markers of Cardiovascular Risk in Chronic Kidney Disease Patients

Abstract

Background: Kidney transplant (Tx) patients present a reduced cardiovascular (CV) mortality in comparison to the dialysis population, but in comparison to the general population, it is still several-fold higher. Methods: We studied risk factors for CV disease in a group of 38 patients (50% males, median age 36 years) who underwent a living donor Tx at the baseline and after 3 ± 1 and 9 ± 2 months. Results: The prevalence of overweight increased from 26 to 54% after Tx (p < 0.001). The mean systolic blood pressure decreased significantly after the Tx (148 ± 27.6 vs. 126 ± 12.7 mm Hg). There was a significant increase in LDL (97 ± 30 vs. 114 ± 35) and hematocrit (33.8 ± 4.4 to 42 ± 5.7%) levels and a significant reduction in fibrinogen levels (394 ± 91 vs. 366 ± 100 mg/dl) after 9 months as compared to the baseline. Obesity and dislipidemia were significantly correlated with inflammation. Significant changes in left ventricle mass index (293 ± 116 vs. 241 ± 96) were observed after the Tx. Patients with a low glomerular filtration rate (GFR) in the follow-up evaluation presented higher LDL (128 ± 7 vs. 99 ± 7 mg/dl; p < 0.05) and higher fibrinogen levels (399 ± 21 vs. 332 ± 22 mg/dl; p < 0.05) compared to patients with a high GFR. Conclusion: Most of the risk factors analyzed (particularly the uremia-related) improved after the renal Tx, which could justify the positive impact of Tx on the development of CV disease. Inflammation and dyslipidemia were related to renal dysfunction after the Tx, suggesting that complete restoration of renal function may have an impact on reducing CV mortality in CKD patients treated with renal Tx.

Association between Biomarkers of Carbonyl Stress with Increased Systemic Inflammatory Response in Different Stages of Chronic Kidney Disease and after Renal Transplantation

“…The reduction in carbonyls was previously reported in another study similar in design and population, although in that study there was no description of plasma thiol changes after transplantation. In studies performed in transplant patients, we [10] and others [11,12] have described that there was an improvement in the inflammatory status (according to the evaluation of several biomarkers, such as fibrinogen and CRP) after correction of renal function, which was dependent on the degree of renal function observed after the procedure. These observations of an improvement in inflammatory status in combination with a reduction in oxidative stress may justify the decrease in cardiovascular risk observed in transplant patients when compared to patients on dialysis.…”

Left Ventricular Mass in Chronic Kidney Disease and ESRD

“…However, it must be made clear that no appropriately designed prospective randomized trial has yet shown that lowering phosphorus per se (independent from other factors) can prevent or cause regression of LVH in CKD or ESRD. Finally, renal transplant consistently reduces LVH in dialysis patients after 9 mo of post-transplant follow-up (75), suggesting that the most important determinant of the hypertrophy reduction may be the re-establishment of renal function. Closure of AVFs after transplant may also have a beneficial effect on LVH (51).…”

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…Larger scale studies are needed to investigate the effect of ACE inhibition on LV dimension and function and on clinical outcomes of CHF in patients with ESRD. Renal transplantation has been shown to consistently reduce LVH in dialysis patients after transplant 80, 81, 84, 85. This suggests that the most effective method of treating LVH and the associated impaired LV dysfunction is restoring renal function 80, 81…”

“…Renal transplantation has been shown to consistently reduce LVH in dialysis patients after transplant. 80,81,84,85 This suggests that the most effective method of treating LVH and the associated impaired LV dysfunction is restoring renal function. 80,81 Device Therapy for Primary Prevention of Sudden Cardiac Death Severe LV systolic dysfunction (LVEF <35%) in patients with ESRD raises a question about primary prevention of fatal cardiac arrhythmias with device therapy.…”