Advances in Transplantology
Kidney transplantation
Prediction of Cardiovascular Events After Renal Transplantation

https://doi.org/10.1016/j.transproceed.2014.12.014Get rights and content

Highlights

  • This was a prospective study including 64 renal transplant recipients, in which 15 suffered from a cardiovascular event and 49 did not.

  • Assessment was made of pulse wave velocity, augmentation index, central aortic pressure, peripheral blood pressure, and pulse pressure.

  • Binary logistic regression revealed a significant correlation between pulse wave velocity and cardiovascular events among renal transplant recipients.

Abstract

Background

Pulse wave velocity (PWV) is a marker of arterial stiffness and predicts cardiovascular events in the nontransplantation population. Cardiovascular events (CVE) are the leading cause of death and one of the leading causes of graft failure in renal transplant recipients. The present prospective study investigates whether there is a correlation between PWV and CVE in renal transplant recipients.

Methods

A prospective study assessing the incidence of a composite cardiovascular endpoint within ≥3 years after pulse wave analysis was performed in 64 stable renal transplant recipients. Measurement of PWV, augmentation index (AI75), and aortic systolic pressure was conducted using the SphygmoCor (AtCor) device. The composite endpoint of the study was the incidence of either death, myocardial infarction, stroke, or admission for symptomatic intermittent claudication or decompensated congestive heart failure.

Results

Fifteen patients (23%) reached the composite endpoint during a follow-up of 4.4 years. Binary logistic regression using PWV, AI75, central aortic systolic pressure, peripheral systolic pressure, and pulse pressure as covariates revealed that PWV was significantly associated with cardiovascular events (10.1 ± 3.6 m/s in subjects reaching the endpoint vs 8.5 ± 1.5 m/s in subjects not reaching the endpoint; P = .048).

Conclusion

Increased arterial stiffness as assessed by PWV predicts CVE in renal transplant recipients and may be regarded as a footprint of accelerated arteriosclerosis for those patients.

Section snippets

Study Population and Protocol

Patients were recruited at the transplantation center of a university hospital at Berlin, Germany (Charité – Campus Benjamin Franklin). For reasons of comparability of pulse wave analysis, bilateral fistula was regarded as an exclusion criterion. Inclusion criteria were written informed consent for participation and renal transplantation ≥3 months ago with a functioning graft. Transplantation <3 months ago was defined as an exclusion criterion because we have previously shown that changes in

Results

Sixty-four patients were enrolled in the study. Epidemiological information, data on transplantation and graft function, cause of ESRD, concomitant diseases, and traditional cardiovascular risk factors are presented in Table 1. Median age was 52 years (interquartile range, 42.5–61). Patients were on dialysis for a median of 64 months (interquartile range, 24–84.5) and the median post-transplantation period was 96 months (interquartile range, 60–165). The predominant cause of ESRD was

Discussion

Arterial stiffness reflects the extent of arteriosclerosis and is an independent predictor of CVE in both the general population and the dialysis population. To date, it remained elusive whether pulse wave analysis can be used to assess cardiovascular risk after renal transplantation as well. The present study shows for the first time that PWV is indeed an independent predictor of fatal and nonfatal CVE in renal allograft recipients. PWV was significantly higher in those patients suffering from

Acknowledgment

We would like to thank Mrs Simone Voigt for her unfailing support in our research.

References (37)

  • A.K. Jacobs et al.

    ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

    Circulation

    (2013)
  • J. Blacher et al.

    Impact of aortic stiffness on survival in end-stage renal disease

    Circulation

    (1999)
  • S. Laurent et al.

    Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients

    Hypertension

    (2001)
  • G.M. London et al.

    Arterial wave reflections and survival in end-stage renal failure

    Hypertension

    (2001)
  • T.H. Westhoff et al.

    Time-dependent effects of cadaveric renal transplantation on arterial compliance in patients with end-stage renal disease

    Transplantation

    (2006)
  • F. Seibert et al.

    Differential effects of cyclosporine and tacrolimus on arterial function

    Transplant Int

    (2011)
  • T.H. Westhoff et al.

    The impact of FTY720 (fingolimod) on vasodilatory function and arterial elasticity in renal transplant patients

    Nephrol Dial Transplant

    (2007)
  • E. Agabiti-Rosei et al.

    Central blood pressure measurements and antihypertensive therapy: a consensus document

    Hypertension

    (2007)
  • Cited by (14)

    • Aerobic or resistance training and pulse wave velocity in kidney transplant recipients: A 12-week pilot randomized controlled trial (the Exercise in Renal Transplant [ExeRT] Trial)

      2015, American Journal of Kidney Diseases
      Citation Excerpt :

      The association of higher heart rate at rest and higher PWV measurement has been suggested in several studies,41-43 including the potentially unfavorable effect of calcineurin inhibitors on heart rate at rest44 and PWV.45 The acute influence of calcineurin inhibitor levels on arterial elasticity has also been postulated.46 Although PWV was measured at the same time of day, individual patient calcineurin inhibitor ingestion time was not monitored.

    • Comparative Analysis of Arterial Stiffness and Body Composition in Early and Late Periods After Kidney Transplantation

      2018, Transplantation Proceedings
      Citation Excerpt :

      It has been demonstrated that dyslipidemia, increased total cholesterol, LDL, and triglycerides lead to increased arterial stiffness and thus accelerate the occurrence of atherosclerosis. Seibert et al [7] conducted studies on the occurrence of CVD in patients after KTx and found that PWV was the only significant statistical parameter associated with the cardiovascular events (10.1 ± 3.6 m/s vs 8.5 ± 1.5 m/s, P = .048). Parameters such as aortic systolic pressure (115 ± 28 vs 118.7 mm Hg, P = .635), SBP (130.5 ± 29.9 mm Hg vs 131.7 ± 17 mm Hg, P = .408), and pulse (62.3 ± 17.3 mm Hg vs 56.8 ± 12.1 mm Hg, P = .128) showed no significant correlation.

    • 24-hour Arterial Stiffness Monitoring in Kidney Transplant Recipients in the Early Postoperative Period

      2018, Transplantation Proceedings
      Citation Excerpt :

      The authors demonstrated higher BMI values and higher serum calcium levels to be independent risk factors affecting the post-transplantation PWV value. Seibert et al [13] conducted studies on the incidence of CVEs in KTx patients and demonstrated that PWV was the only statistically significant measure associated with CVEs in KTx recipients (PWV of 10.1 ± 3.6 m/s in patients who developed a predefined CVE vs 8.5 ± 1.5 m/s in those who did not; P = .048). No significant correlation was shown for such parameters as aortic SBP (115 ± 28 vs 118.7 mm Hg; P = .635), peripheral SBP (130.5 ± 29.9 vs 131.7 ± 17 mm Hg; P = .408), or PP (62.3 ± 17.3 vs 56.8 ± 12.1 mm Hg; P = .128).

    View all citing articles on Scopus
    View full text