Betül CENGİZ ELÇİOĞLU, Yasemin DEMİRCİ, Mert Pehlivan ALTIN, Erol GÜRSOY, Vedat AYTEKIN, Saide AYTEKIN

Evaluation of cardiovascular risk factors, prevalence and determinants of coronary artery disease in renal transplant patients: a single center experience

Objective: Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant patients. In our study, we aimed to determine the cardiovascular (CV) risk factors, the prevalence and determinants of coronary artery disease (CAD) in patients who underwent kidney transplantation in our center. Material and Methods: One hundred sixty nine patients who underwent kidney transplantation in our center were included in the study retrospectively. Demographic and clinical characteristics of the patients, cardiac evaluation findings and further examination results were scanned from the database of our center. Results: The mean age of the patients was 42.86±12.97 years and 43.19% were female. The most common etiological factors for the development of end-stage renal disease were hypertension (HT) and diabetes mellitus (DM). Ninety seven patients (57.4%) were undergoing dialysis, 4 of whom were on peritoneal dialysis. Renal transplant was performed from a cadaver in two patients and from a living donor in the other patients. CAD was detected in 29 patients (17.15%). The most prevalent CV risk factors were HT and hyperlipidemia (HL). Multivariate logistic regression analysis revealed that age, DM, HL and dialysis history were independent risk factors for the development of CAD. In the postoperative follow-ups, no death or acute coronary syndrome was observed during the hospitalization period. Conclusion: Prevalence of CV risk factors is high in renal transplant candidates. Our findings support the need for a detailed cardiac evaluation and effective management of CV risk factors in patients preparing for kidney transplantation.

Keywords:

Renal transplantation, end-stage renal disease, preoperative cardiac evaluation, cardiovascular risk in renal transplant patients,

PDF

___

Laupacis A, Keown P, Pus N, et al. A study of the quality of life and cost-utility of renal transplantation. Kidney Int. 1996;50(1):235-242.
Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975-1982.
Seyahi N, Ateş K, Süleymanlar G. Current status of renal replacement therapies in Turkey: summary of Turkish Society of Nephrology Registry 2016 report. Turkish J Nephrol. 2018;27:133-139.
Stevens PE, O’Donoghue DJ, de Lusignan S, et al. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int. 2007;72(1):92-99.
Thompson S, James M, Wiebe N, et al. Cause of death in patients with reduced kidney function. J Am Soc Nephrol. 2015;26(10):2504-2511.
Hou F, Jiang J, Chen J, et al. China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis. BMC Nephrol. 2012;13:94.
Jardine AG, Gaston RS, Fellstrom BC, Holdaas H. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet. 2011;378(9800):1419-1427.
Buglioni A, Burnett JC Jr. Pathophysiology and the cardiorenal connection in heart failure. Circulating hormones: biomarkers or mediators. Clin Chim Acta. 2015;443:3-8.
Mathur AK, Chang YH, Steidley DE, et al. Patterns of care and outcomes in cardiovascular disease after kidney transplantation in the United States. Transplant Direct. 2017;3(2):e126.
Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2017 annual data report: kidney. Am J Transplant. 2019;19 Suppl 2:19-123.
Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924.
Chadban SJ, Ahn C, Axelrod DA, et al. KDIGO Clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation. 2020;104(4S1 Suppl 1):S11-S103.
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;10.1097/HJH.0000000000003480.
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(8):736-743.
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-612.
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-2100.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.
Luxardo R, Kramer A, González-Bedat MC, et al. The epidemiology of renal replacement therapy in two different parts of the world: the Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry. Rev Panam Salud Publica. 2018;42:e87
El Ghoul B, Daaboul Y, Korjian S, et al. Etiology of end-stage renal disease and arterial stiffness among hemodialysis patients. Biomed Res Int. 2017;2017:2543262.
Kocabas U. Cardiovascular diseases and risk factors in kidney transplant candidates. Eur Res J. 2021;7(5):524-532.
Fazelzadeh A, Mehdizadeh A, Ostovan MA, Raiss-Jalali GA. Incidence of cardiovascular risk factors and complications before and after kidney transplantation. Transplant Proc. 2006;38(2):506-608.
Gonçalves M, Vieira P, Resende L, et al. Metabolic profile and cardiovascular risk in a population of renal transplant recipients. Transplant Proc. 2015;47(4):985-988.
Domenic A. Sica. The kidney and hypertension: causes and treatment. J Clin Hypertens (Greenwich). 2008;10(7):541-548.
Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071-1081.
Giorda CB, Carnà P, Salomone M, et al. Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes. Acta Diabetol. 2018;55(7):733-740.
Keddis MT, El Ters M, Rodrigo E, et al. Enhanced posttransplant management of patients with diabetes improves patient outcomes. Kidney Int. 2014;86(3):610-618.
Dolla C, Naso E, Mella A, et al. Impact of type 2 diabetes mellitus on kidney transplant rates and clinical outcomes among waitlisted candidates in a single center European experience. Sci Rep. 2020;10(1):22000.
Goyal A, Chatterjee K, Mathew RO, et al. In-hospital mortality and major adverse cardiovascular events after kidney transplantation in the United States. Cardiorenal Med. 2019;9(1):51-60.
Chan DT, Dogra GK, Irish AB, et al. Chronic kidney disease delays VLDL-apoB-100 particle catabolism: potential role of apolipoprotein C-III. J Lipid Res. 2009;50(12):2524-2531.
Tonelli M, Isles C, Curhan GC, et al. Effect of pravastatin on cardiovascular events in people with chronic kidney disease. Circulation. 2004;110(12):1557-1563.
Holdaas H, Fellström B, Jardine AG, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet. 2003;361(9374):2024-2031.
Kasiske BL, Klinger D. Cigarette smoking in renal transplant recipients. J Am Soc Nephrol. 2000;11(4):753-759.
Malyala R, Rapi L, Nash MM, Prasad GVR. Pre-transplant left ventricular geometry and major adverse cardiovascular events after kidney transplantation. Ann Transplant. 2019;24:100-107.
Paoletti E, Bellino D, Signori A, et al. Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study. Nephrol Dial Transplant. 2016;31(7):1168-1174.
Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation. 2012;126(5):617-663.
Abramowicz D, Cochat P, Claas FH, et al. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant. 2015;30(11):1790-1797.
Cai Q, Mukku VK, Ahmad M. Coronary artery disease in patients with chronic kidney disease: a clinical update. Curr Cardiol Rev. 2013;9(4):331-339.