Ambient Air Pollutants and Risk of Fatal Coronary Heart Disease Among Kidney Transplant Recipients (original) (raw)
Related papers
Is inflammation prior to renal transplantation predictive for cardiovascular and renal outcomes?
Atherosclerosis, 2010
Objectives: Markers of non-specific inflammation, such as C-reactive protein (CRP) or leukocyte count are increased in end-stage renal disease patients. Recent studies have shown positive associations between inflammatory markers and cardiovascular mortality in kidney transplant recipients, but these analyses had been limited by sample size. The aim of our study was to determine the association between pretransplant CRP levels and leukocyte counts with posttransplant outcome in a prospectively enrolled cohort of kidney transplant recipients. Methods: 459 consecutive patients transplanted from July 1995 to December 2007 were analyzed. Both markers were obtained prior to transplantation and patients were grouped according to baseline CRP levels (<5 mg/l or ≥5 mg/l) or leukocyte counts (<10,000/l or ≥10,000/l). Results: Major cardiac events were associated with elevated pretransplant CRP levels (p < 0.00003) but not leukocyte counts. Furthermore, more acute rejection episodes within 4 weeks or 6 months, as well as a lower probability of survival at 6 months were found in patients with elevated pretransplant CRP levels or leukocyte counts. Conclusion: Elevated pretransplant serum CRP level is a risk predictor for major cardiac events in renal transplant patients. It is also predictive, besides leukocyte counts, for acute rejection episodes. Elevated CRP levels and initial high leukocyte counts may prove to be useful markers for posttransplant course and warrant the close follow-up of such patients.
In Renal Transplanted Patients Inflammation and Oxidative Stress Are Interrelated
Transplantation Proceedings, 2006
Introduction. The inflammatory state plays a well-documented role to cause oxidative stress, especially in end-stage renal disease (ESRD) patients, wherein several cardiovascular risk factors are amplified by the coexistence of a microinflammatory state with increased oxidative stress. Methods. We measured serum concentrations of high sensitivity C-reactive protein (CRP), tumor necrosis factor ␣ (TNF␣), 8-iso-prostaglandin F2␣ (8-iso-PGF2␣-in vivo oxidative stress marker) in 15 chronic renal failure (CRF) and 15 transplant patients versus 15 healthy controls. Exclusion criteria were: age Ͻ30 or Ͼ65 years as well as a diagnosis of diabetes or cardiovascular diseases. We evaluated systolic (SBP) and diastolic blood pressure (DBP), serum creatinine (sCr), and glomerular filtration rate (GFR). Results. Both the transplanted and the CRF group showed significantly higher values of CRP, TNF␣, and 8-iso-PGF2␣ than the controls (P Ͻ .05 for all). SBP, DBP, and sCr were not different between transplanted and CRF patients. CRP was higher in transplant recipients than in CRF patients (P Ͻ .05). No difference in TNF␣ levels was observed between the two groups. 8-iso-PGF2␣ was significantly higher in the CRF than in the transplanted group (P Ͻ .05), although the latter cohort showed a positive correlation between 8-iso-PGF2␣ and TNF␣ (P Ͻ .001), sCr (P Ͻ .001), SBP (P Ͻ .05), and DBP (P Ͻ .05). In the same group both 8-iso-PGF2␣ and TNF␣ were negatively correlated with GFR (r Ϫ.824 and Ϫ.866, respectively; P Ͻ .001 for both). Conclusion. We observed the coexistence of increased oxidative stress and an inflammatory state among renal graft recipients.
Transplantation, 2010
Background. Cardiovascular disease (CVD) represents the main cause of morbidity and mortality after renal transplantation. In view of the modern paradigm of atherosclerosis as an inflammatory disease, this study investigated the impact of inflammatory cytokine polymorphisms on posttransplant CVD. Methods. The association between cytokine polymorphisms and CVD was assessed in a case-control study to identify the differences in genotype distributions between kidney allografts with or without posttransplant CVD. To validate our results in two independent groups, we divided a cohort of 798 renal transplant recipients according to geographic area: an evaluation cohort of 478 patients from Emilia-Romagna and a validation cohort of 320 patients from the rest of Italy. Tumor necrosis factor (TNF)-␣, transforming growth factor-1, interleukin (IL)-10, IL-6, interferon-␥, and IL-8 polymorphisms were analyzed, and thereafter, the cytokine production genotype was assigned. Results. In the evaluation cohort, the patients in the CVD and no-CVD groups differed significantly in TNF-␣ and IL-10 genotype frequencies. Using multivariate analyses to test the association with CVD, the TNF-␣ high-producer genotype was associated with a significantly increased cardiovascular risk (odds ratio [OR]ϭ4.41, 95% confidence interval (CI)ϭ2.53-7.67). Conversely, the IL-10 high-producer genotype resulted protective against CVD (ORϭ0.07, 95% CIϭ0.02-0.29). These findings were confirmed in the validation cohort where the carriers of the TNF-␣ highproducer genotype proved to be at 2.45-fold increased cardiovascular risk (ORϭ2.45, 95% CIϭ1.29-4.63), whereas the IL-10 high-producer genotype was associated with a 0.08-fold reduced risk (ORϭ0.08, 95% CIϭ0.02-0.36). Conclusions. This work suggests a prognostic value of TNF-␣ and IL-10 genotypes, which might represent cardiovascular risk markers in renal transplant.
Inflammation and Atherosclerosis Are Associated With Hypertension in Kidney Transplant Recipients
The Journal of Clinical Hypertension, 2015
The aim of the current study was to evaluate risk factors associated with hypertension in kidney transplant recipients. The authors recruited 92 consecutive kidney transplant recipients and 30 age-matched patients with chronic kidney disease without history of cardiovascular events. Twentyfour-hour ambulatory blood pressure monitoring, pulse wave velocity, and carotid ultrasound were performed. Serum levels of log-transformed interleukin 6 (Log IL-6), soluble tumor necrosis factor receptor 2, and intercellular adhesion molecule 1 were determined. Twenty-four-hour systolic blood pressure (SBP) (P=.
International Urology and Nephrology, 2006
Reactive oxygen species (ROS) are important mediators of cellular damage and lipid peroxidation is the most important expression of ROS-induced oxidative stress. Recent studies have suggested that increased plasma malondialdehyde (MDA) levels are a consequence of specific immunosuppressive therapies. This study aims at investigating the relation between oxidative stress and immunosuppressive therapies in renal transplant patients with stable renal function and uneventful postoperative course. The study group included 26 renal patients. Two groups of renal transplant recipients, treated with a different combination of immunosuppressive agents were studied (Group A: CyA, MMF, Steroids and Basiliximab, Group B: Tacrolimus, MMF, Steroids and Daclizumab). All patients had an uneventful postoperative course. Plasma MDA levels were measured before transplantation, 1 and 6 months after. Plasma concentration of endogenous creatinine (Cr) was used as a measure of stable renal function. Levels of MDA were increased before the transplantation in all renal patients (MDA: 7.81 +/- 4.81, normal levels: 2.23-4.08 nmol/ml, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Combined therapy with CyA was associated with high values of MDA at 6 months measurement after transplantation. However this tendency of increased MDA levels did not achieve a statistical significance (Group A: 6.97 vs. 9.06 nmol/ml, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). On the contrary, statistically significant diminution of MDA levels was observed in Group B patients (Tacrolimus-MMF-steroids) at 6 months measurement after transplantation. (Group B: 8.61 vs. 4.11 nmol/ml, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.02&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Immunosuppressive combined therapy with CyA was associated with the high values of MDA that were measured posttransplantly. Our study provides strong evidence that Tacrolimus is significantly associated with improved free radical metabolism.
Impact of Subclinical Borderline Inflammation on Kidney Transplant Outcomes
Transplantation Direct, 2021
interstitial inflammation (i) peritubular capillaritis (ptc) interstitial fibrosis (ci) chronic vasculopathy (cv) transplant glomerulopathy (cg) mesangial matrix increase (mm) arteriolar hyalinosis (ah) C4d staining of peritubular capillaries (C4d) glomerulitis (g) tubular atrophy (ct) SCI (n=137)
Renal failure, 2012
Objectives: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and is also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima-media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in the end-stage renal disease (ESRD) patients. Ischemia-modified albumin (IMA), pentraxin-3 (PTX-3), and neutrophil-to-lymphocyte ratio (NLR) were introduced as oxidative stress and inflammatory biomarkers in ESRD. The role of Rtx in terms of atherogenesis, oxidative stress, and inflammation is still unclear. We aimed to investigate the relationship between IMA, PTX-3, NLR, and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects and ESRD patients receiving hemodialysis (HD) and peritoneal dialysis (PD). Design and methods: Cross-sectional analysis in which CIMT measurements, NLR, and serum PTX-3 and IMA levels were assessed in 18 Rtx patients (10 females; mean age: 40.0 AE 13.3 years), 16 PD patients (7 females; 40.2 AE 12.9 years), 14 HD patients (8 females; 46.6 AE 10.7 years), and 19 healthy subjects (9 females; 36.9 AE 8.9 years). Results: IMA, PTX-3, and high-sensitive C-reactive protein (hs-CRP) levels, NLR, and CIMT of Rtx patients were found to be significantly higher compared with healthy subjects ( p ¼ 0.04, p < 0.0001, p < 0.005, p ¼ 0.005, and p ¼ 0.005, respectively). IMA level was positively correlated with hs-CRP and PTX-3 levels, NLR, and CIMT when all participants were included (r ¼ 0.338, p ¼ 0.005; r ¼ 0.485, p < 0.0001; r ¼ 0.304, p ¼ 0.013; and r ¼ 0.499, p < 0.0001, respectively). Conclusion: There has been ongoing inflammation, oxidative stress, and atherosclerosis in Rtx patients.