Cardiovascular mortality in renal transplant (original) (raw)
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Clinical and Experimental Nephrology, 2021
Background: The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of CV events and death during the first 12 months after transplantation. Methods: Based on data collected prospectively during pre-transplant workup, a retrospective study was conducted including 665 patients followed up until death or completing 12 months post-transplantation. Endpoints were the composite incidence of CV events and death. Results: The prevalence of diabetes, LV hypertrophy and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease (CAD). CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age ≥ 50 years (HR: 2.292; CI%: 1.093-4.806), angina (HR: 1.969; CI%: 1.039-3.732), and altered myocardial scan (HR: 1.905, CI% 1.059-3.428). Altered myocardial scan (HR: 2.601; CI%: 1.129-5.988) was the sole predictor of CV death. Conclusion: The incidence of CV events and death were predicted by variables associated with myocardial ischemia. Patients with pre-transplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after the operation.
BMC Cardiovascular Disorders, 2011
Background: Cardiovascular disease (CVD) is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, Regicor, SCORE, and DORICA) to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design: Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain) in the period 1981-2008 (2059 transplants corresponding to 1794 patients). The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pretransplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease). Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE) equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry)), and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk) functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk Reduction), RRR (Relative Risk Reduction) and NNT (Number Needed to Treat). The ability of different cardiovascular risk scores to predict cardiovascular events will be analyzed by using the c index and the area under ROC curves. Based on the competing risks analysis, a nomogram to predict the probability of cardiovascular events after kidney transplantation will be developed. Discussion: This study will make it possible to determine the post-transplant incidence of cardiovascular events in a large cohort of renal transplant recipients in Spain, to confirm the relationship between traditional and transplant-specific cardiovascular risk factors and CVD, and to develop a score to predict the risk of CVD in these patients.
Cardiovascular disease and kidney transplantation‑evaluation of potential transplant recipient
Polish Archives of Internal Medicine, 2014
Nowadays, from 50% to 60% of deaths can be directly attributed to CVD, with an incidence of ischemic heart disease being approximately 1 per 100 person-years at risk. 3 In contrast, some older studies reported that between 17% and 50% of deaths in kidney transplant recipients were due to CVD. 4 Moreover, CVD is the most common cause of death in kidney allograft recipients with a functioning graft, and accounts for 30% of overall graft loss from death, with the greatest rates in Cardiovascular disease and kidney disease Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients on renal replacement therapy, including kidney transplant recipients. 1 Death from CVD is also the most common cause of graft loss. 2 Mortality associated with kidney transplantation decreased significantly in the 1960s and 1980s owing to a reduction in the incidence of infection-related deaths, 2 while cardiovascular mortality increased.
Cardiac risk assessment for end-stage renal disease patients on the renal transplant waiting list
Clinical Kidney Journal, 2019
Cardiovascular disease is a leading cause of morbidity and mortality and is becoming more prevalent as the population ages and risk factors increase. This is most apparent in the end-stage renal disease (ESRD) patient population. In part, this is due to cofactors such as diabetes and hypertension commonly predisposing to progressive renal disease, as well as being a direct consequence of having renal failure. Of all major organ failures, kidney failure is the most likely to be managed chronically using renal replacement therapy and, ultimately, transplant. However, lack of transplant organs and a large renal failure cohort means waiting lists are often quite long and may extend to 5–10 years. Due to the cardiac risk factors inherent in patients awaiting transplant, many succumb to cardiac issues while waiting and present an increased per-procedural cardiac risk that extends into the post-transplant period. We aim to review the epidemiology of coronary artery disease in this populati...
Cardiovascular morbidity and risk factors in renal transplant patients
Nephrology Dialysis Transplantation, 1999
for 55% of their total mortality [1]. The cardiovascular Background. Cardiovascular disease is now the major mortality is, however, significantly higher in the cause of death in renal transplant patients. This study Northern than in the Southern parts of Europe [2]. aimed to assess the prevalence of cardiovascular disease Thus, cardiovascular mortality rates in renal transplant in stable renal transplant patients as compared with patients in Norway are particularly high, and up to 10 the general background population, and to assess risk times higher than found in Southern Europe [3]. factors for cardiovascular disease in this patient group. Whereas in European renal transplant patients at large, Methods. A cross-sectional multicentre study compriscardiovascular disease accounts for 36% of the total ing 406 stable renal transplant patients (age 47±16 late mortality [3], ischaemic heart disease alone causes years, 60% males, 71% taking cyclosporin A) were as much as 53% of deaths in these patients in assessed clinically and biochemically 48 months Scandinavia [4]. (median) after transplantation and compared with the Only a few studies have compared mortality in general population. Multivariate analysis was used to patients on renal replacement therapy in general with assess the relation between cardiovascular disease and that of the background population [3-5], and to our risk factors. knowledge none has assessed the cardiovascular mor-Results. Hypertension was present in 55% of males bidity specifically in renal transplant patients in the and 34% of females (P<0.001), in 51% with cyclospocyclosporin era. rin A and in 33% without (P<0.001). Ischaemic heart Thus, the aims of this study were first to assess the disease (i.e. angina pectoris and/or previous myocardial prevalence of cardiovascular disease in renal transplant infarction) was present in 14% (males: 18%, females: patients using a predominantly cyclosporin A based 10%, P<0.05) and in 24% of diabetics vs 12% of nonimmunosuppressive regimen as compared with the diabetics (P<0.01). Cerebro-and peripheral vascular general background population, and second to evaluate disease was found in 3% and 4%, respectively. Odds the relation between cardiovascular disease and risk ratio for angina pectoris (patients vs general populafactors in the patients. tion) was: in age group 40-49 years (males/females), 12/16; 50-59 years, 6/4; 60-69 years, 3/4. Ischaemic heart disease was, besides age and gender, independ-Subjects and methods ently associated with total cholesterol (P<0.01), and peripheral vascular disease to systolic blood pressure The present study extends a recent analysis on hyperlipidae-(P<0.01). mia in renal transplant patients in Norway [6 ]. In all, 406 Conclusions. Cardiovascular disease is highly prevalent stable renal transplant patients completed registration in in renal transplant patients, and is independently asso-1991 at 18 centres of nephrology covering all regions of ciated with age, gender, total cholesterol and systolic Norway. The study patients represented 43% of the total blood pressure. national renal transplant population at the time, and had a similar age and gender distribution. Each patient was assessed Key words: cardiovascular disease; cross-sectional by a nephrologist who recorded patient history, clinical study; cyclosporin A; ischaemic heart disease; renal findings and laboratory investigations. Cause of pretransplant patients; risk factors transplant renal failure was chronic glomerulonephritis in 42.5%, chronic pyelonephritis in 12.8%, diabetic nephropathy in 11.5%, cystic renal disease in 7.6%, other primary renal Cardiovascular disease is now the major cause of death (P<0.05, males vs females). Brachial artery blood pressure in patients on renal replacement therapy and accounts was measured in the sitting position with a manometer and an appropriately sized cuff. A 12-lead electrocardiogram was
BMC Nephrology, 2019
Background: Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Methods: Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Results: Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median 33,271vs.33,271 vs. 33,271vs.28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and nontransplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. Conclusion: KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and nontransplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.
Pre-existing renal failure doubles 30-day mortality after heart transplantation
The Journal of Heart and Lung Transplantation, 2004
on behalf of the steering group of the UK Cardiothoracic Transplant Audit Background: Survival after cardiac transplantation has not changed over the last 10 years. Our objective was to identify risk factors for 30-day mortality after cardiac transplantation with particular reference to focusing on the impact of pre-existing renal dysfunction.
Transplant International, 2008
Introduction Cardiovascular disease is the major cause of death after renal transplantation and the incidence is considerably higher than in the general population [1,2]. The incidence of cardiovascular events and death is highest in the first 3 months after transplantation [2,3]. Several factors seem to play a role in the high incidence of early cardiovascular events in renal transplant recipients. First of all chronic kidney disease is a major risk factor for cardiovascular disease. Patients with a moderate renal insufficiency already have a markedly increased cardiovascular risk [4]. Additionally traditional risk factors are more prevalent in patients with chronic kidney disease [5]. For this reason the prevalence of cardiac disease at the time of transplantation is already high [6]. The high incidence of cardiovascular events late after transplantation also has a multi-factorial origin. Although there is an improved renal function after transplantation, many patients still have a chronic renal insufficiency after transplantation [7]. Besides immunosuppressive medication (e.g. calcineurin inhibitors, corticosteroids) are related to an increased cardiovascular risk [8]. Other non-traditional risk factors such as inflammation and