Cardiovascular Risk Factors in Diabetic Patients With Renal Transplants (original) (raw)
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Diabetes and Cardiovascular Risk in Renal Transplant Patients
International Journal of Molecular Sciences
End-stage kidney disease (ESKD) is a main public health problem, the prevalence of which is continuously increasing worldwide. Due to adverse effects of renal replacement therapies, kidney transplantation seems to be the optimal form of therapy with significantly improved survival, quality of life and diminished overall costs compared with dialysis. However, post-transplant patients frequently suffer from post-transplant diabetes mellitus (PTDM) which an important risk factor for cardiovascular and cardiovascular-related deaths after transplantation. The management of post-transplant diabetes resembles that of diabetes in the general population as it is based on strict glycemic control as well as screening and treatment of common complications. Lifestyle interventions accompanied by the tailoring of immunosuppressive regimen may be of key importance to mitigate PTDM-associated complications in kidney transplant patients. More transplant-specific approach can include the exchange of ...
Metabolic cardiovascular syndrome after renal transplantation
Nephrology Dialysis Transplantation, 2001
Background. Cardiovascular disease (CVD) is the major cause of death in renal transplant recipients. Traditional risk factors like hypertension, dyslipidaemia and diabetes mellitus are common, but cannot completely account for the high prevalence of CVD in this population. The aim of the present study was to assess whether post-transplant glucose intolerance, de®ned as post-transplant diabetes mellitus, impaired glucose tolerance, or impaired fasting glucose, is associated with metabolic disturbances known to increase risk of cardiovascular disease, similar to what has been observed in the general population. Methods. One hundred and seventy-three consecutive patients were prospectively examined 10 weeks after transplantation. An oral glucose tolerance test was completed in 167 patients. Questionnaires, medical records, and the results of various blood tests were used to evaluate a number of known cardiovascular risk factors in all patients. Results. Glucose intolerance was present in about one-half the recipients and was associated with age, a positive family history of ischaemic heart disease, acute rejection, higher levels of serum triglycerides, apolipoprotein B and 2-h insulin, and lower levels of serum HDL cholesterol. After adjustment for age and sex, lower HDL cholesterol (Ps0.005), higher serum triglycerides (P-0.001), apolipoprotein B (Ps0.039) and 2-h insulin (P-0.001) were still associated with post-transplant glucose intolerance. Conclusions. Ten weeks after renal transplantation glucose intolerance is associated with a clustering of cardiovascular risk factors and metabolic abnormalities, consistent with a post-transplant metabolic cardiovascular syndrome.
Transplantation Proceedings, 2008
The aim of this study was to evaluate changes in body mass index (BMI), body fat percentage (BF%), insulin resistance, and lipid profile in 32 patients during the first year after renal transplantation by anthropometric measures. The homeostasis model assessment index (HOMA) was calculated for insulin resistance estimation. Anthropometric measures and biochemical markers were evaluated at the time of transplantation (T 0 ), and prospectively at 3 (T 3 ), 6 (T 6 ), 9 (T 9 ), and 12 (T 12 ) months posttransplantation. The HOMA index decreased significantly at 3 months after transplantation (T 3 ) (2.4 Ϯ 1.5 vs 1.5 Ϯ 1.1; P Ͻ .01); however, an increment was observed at T 6 and T 9 (1.8 Ϯ 0.8 and 2 Ϯ 1.5, respectively), remaining stable at T 12 (2 Ϯ 1.7). BMI and BF% increased significantly over 12 months (23.3 Ϯ 2.7 vs 24.4 Ϯ 2.7 kg/m 2 ; P ϭ .001 and 23.7 Ϯ 7.8 vs 25.6 Ϯ 7.7 %; P ϭ .002). Total cholesterol, low-density lipoprotein cholesterol and triglyceride levels showed significant increases starting at T 3 . In conclusion, insulin resistance decreased transitorily post-renal transplantation. BMI, BF%, and lipid profile showed unfavorable changes during the first year post-renal transplantation.
Cardiovascular Risk factors Analysis in Renal Transplant Recipients
2016
Renal transplantation is currently the preferred treatment modality for virtually all suitable candidates with end-stage renal disease. When compared with the general population, cardiovascular mortality in transplant recipients is increased by nearly 10-fold among patients within the age range of 35 and 44 and at least doubled among those between the ages of 55 and 64. All transplant recipients should currently be considered as coronary heart disease risk. This study was designed to analyze cardio-vascular risk factors among renal transplant patients. To analyze the risk factors for cardiovascular disease in the renal transplant recipients. Analytical study was done in Government Stanley hospital among renal transplant recipients. All recipients’ profile of Age, Sex, Nature of the Donor, Post transplant duration in months was noted. Height and weight were measured. Body mass index was calculated. Waist circumference and Blood pressure were measured. Fasting and 2 hours postprandial...
Metabolic risk factors for cardiovascular disease in pancreas and kidney transplant recipients
Diabetologia, 1991
Hyperinsulinaemia when combined with insulin resistance and hypertriglyceridaemia is a risk factor for cardiovascular disease. We have studied the serum lipid profile and glycaemic control in 27 uraemic diabetic patients, 23 Type 1 (insulin-dependent) diabetic kidney recipients, 18 non-diabetic kidney recipients, and 30 recipients of kidney and pancreas transplants at 6 months post-transplantation. Fasting serum triglycerides were increased in the uraemic diabetic patients and nondiabetic kidney transplanted patients but not in diabetic kidney transplanted patients whether or not they had received a pancreas. Total cholesterol was increased only in the uraemic diabetic patients while HDL cholesterol was normal in all groups. Whithin the pancreas and kidney transplanted group triglyceride values correlated with glomerular filtration rate (r = -0.55) but not with plasma insulin, glycated haemoglobin or kG-value following an intravenous glucose load. Plasma insulin was increased. Whether such isolated hyperinsulinaemia confers an increased risk of cardiovascular disease is not known. There may be adaptive feed-back mechanisms to protect target cells. Increasing the surgical risk in attempts to secure insulin delivery to the portal circulation does not seem warranted.
Nephrology Dialysis Transplantation, 2022
BACKGROUND AND AIMS: Although improvement in histocompatibility matching, immunosuppressive therapy and antimicrobial treatment have led to improved longterm allograft survival, cardiovascular diseases (CVD) remain the major cause of morbidity and mortality in kidney transplant recipients (KTR). In addition to the accumulated risks due to chronic kidney disease and dialysis, kidney transplantation conveys its own unique risk factors for CVD. These include the metabolic effects of immunosuppressive treatments such as post-transplant hyperglycaemia, dyslipidaemia and hypertension as well as the effects of suboptimal kidney function including volume overload, anaemia, mineral bone disease and left ventricular hypertrophy. The predictors of cardiovascular diseases in KTR, however, have not been clearly defined. This study aimed to first ascertain the incidence of post-transplant CVD in those KTR without a prior confirmed history of CVD, then identify the predictors of CVD transplant associated CVD risk factors and finally evaluate the impact of CVD on graft and patient survival in this era of modern immunosuppressive medications. METHOD: We evaluated 962 KTR transplanted between 2000 and 2020 and followed in a single centre. About 328 KTR with a history of pre transplant CVD were excluded. CVD was defined as a composite of Ischaemic heart disease, myocardial infarction, heart failure, stroke or peripheral vascular disease. Logistic regression analyses were performed to identify the risk predictors of post-transplant CVD. Kaplan-Meier plots
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.
Metabolic Profile and Cardiovascular Risk in a Population of Renal Transplant Recipients
Transplantation Proceedings, 2015
Introduction. Cardiovascular disease is more common in renal transplant recipients (RTRs) than in the general population, and is the major cause of both graft loss and patient death in RTRs. Objectives. This study aimed to characterize the cardiovascular risk factors, calculate the 7-year risk for major adverse cardiac events and the 7-year risk for death in a population of RTRs using a cardiovascular risk calculator, and determine the main cardiovascular risk factors associated with increased prediction of major adverse cardiac event (MACE) and death. Patients. This is a retrospective review of clinical data from 121 RTRs who are in followup programs at our institution, and who had a functioning and stable graft for longer than 6 months. Results. Among 121 adult patients followed at our institution (59.5% males, mean age of 49.6 AE 13.8 years, mean times for functioning grafts were 105 AE 73.5 mo), 86.8% had hypertension, 19.8% had diabetes, 24.8% were current or former smokers, 61.9% had increased body mass index, and 71% had dyslipidemia. The 7-year risk for MACE was more than 10% in 38 (31.4%) patients with age, diabetes, and smoke being independent risk predictors. The 7-year risk for death was more than 10% in 56 (46.3%) patients with age, diabetes, blood pressure, smoking, and male gender being independent risk predictors. Conclusion. There is a high prevalence of cardiovascular risk factors in a population of RTRs, and there is increased risk for MACE and death. Accurate risk prediction is important for physician decision support and patient education, promoting improved cardiovascular health of RTRs, and thus prolonging the survival of both patients and graft.