Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies

Rangaswami, Janani; Mathew, Roy; Parasuraman, Raviprasenna; Tantisattamo, Ekamol; Lubetzky, Michelle; Rao, Swati; Yaqub, Muhammad S.; Birdwell, Kelly A.; Bennett, William M.; Dalal, Pranav; Kapoor, Rajan; Lerma, Edgar V.; Lerman, Mark; McCormick, Nicole D.; Bangalore, Sripal; McCullough, Peter A.; Dadhania, Darshana

doi:10.1093/ndt/gfz053

Cited by 140 publications

(120 citation statements)

References 135 publications

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“…The baseline differences, as compared for the aorto-iliac CaScore tertiles, are in line with previous studies on cardiovascular risk stratification prior to kidney transplantation [2]. The traditional risk factors, i.e., male gender, age, BMI, current or former smoker, hypercholesterolemia, and hypertension, and the transplant candidate-specific risk factor dialysis vintage pre-transplantation, were more prevalent in the medium and high CaScore tertiles.…”

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

“…Kidney transplantation improves survival of patients with end-stage renal disease (ESRD) and reduces cardiovascular disease burden [1,2]. Despite the improved prognosis after transplantation, patients remain vulnerable, with cardiovascular disease as the leading cause of death [2,3]. A high overall prevalence of cardiovascular disease in the first year after kidney transplantation is reported, with myocardial infarction (MI) in 5.1%, cerebrovascular accident (CVA)/transient ischemic attack (TIA) in 7.3%, and peripheral artery disease (PAD) in 15.8% of patients [2,4].…”

Section: Introductionmentioning

confidence: 99%

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Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Benjamens

Rijkse

Velde-Keyzer

et al. 2020

JCM

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As vascular calcification is common in kidney transplant candidates, aorto-iliac vessel imaging is performed for surgical planning. The aim of the present study was to investigate whether a novel non-contrast enhanced computed tomography-based quantification technique for aorto-iliac calcification can be used for cardiovascular risk stratification prior to kidney transplantation. In this dual-center cohort study, we measured the aorto-iliac calcium score (CaScore) of 547 patients within three years prior to transplantation (2005–2018). During a median (interquartile range) follow-up of 3.1 (1.4, 5.2) years after transplantation, 80 (14.7%) patients died, of which 32 (40.0%) died due to cardiovascular causes, and 84 (15.5%) patients had a cardiovascular event. Kaplan-Meier survival curves showed significant differences between the CaScore tertiles for cumulative overall-survival (Log-rank test p < 0.0001), cardiovascular survival (p < 0.0001), and cardiovascular event-free survival (p < 0.001). In multivariable Cox regression, the aorto-iliac CaScore was associated with all-cause mortality (hazard ratio 1.53, 95%CI 1.14–2.06, p = 0.005), cardiovascular mortality (2.04, 1.20–3.45, p = 0.008), and cardiovascular events (1.35, 1.01–1.80, p = 0.042). These independent associations of the aorto-iliac CaScore with the outcome measures can improve the identification of patients at risk for (cardiovascular) death and those who could potentially benefit from stringent cardiovascular monitoring to improve their prognosis after transplantation.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Benjamens

Rijkse

Velde-Keyzer

et al. 2020

JCM

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“…Vascular calci cation is common in patients with ESRD, and the related cardiovascular complications are the main causes of mortality in patients with ESRD. Renal replacement therapy including hemodialysis, peritoneal dialysis, and renal transplantation are the main treatments for patients with ESRD [2]. Vascular medial calci cation is mainly contributed to calcium and phosphate deposition [5,18].…”

Section: Discussionmentioning

confidence: 99%

“…Vascular calci cation is mainly characterized as the medial of aortic calci cation (termed as Mönckeberg's calci cation), and it often happens in patients with chronic kidney disease, especially end stage renal disease (ESRD) [1,2]. Lots of studies have demonstrated that vascular calci cation is not a simple passive process of calcium and phosphorus deposition but an active regulatory process, and the transdifferentiation of vascular smooth muscle cells (VSMCs) into osteoblast-like cells is regarded to be the key pathophysiological factor of vascular calci cation [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Plasma exosomes derived from patients with end-stage renal disease and renal transplant recipients have different effects on vascular calcification

Lin

Zhu²,

Xing³

et al. 2020

Preprint

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Background End-stage renal disease (ESRD) patients usually develop extensive and progressive vascular calcification, and lots of calcification inhibitors as well as pro-calcifying factors are involved in the process. However, the mechanisms of vascular calcification in ESRD patients are still ill-defined. Methods The participants in the study were selected at the Second Xiangya Hospital, Central South University, and the plasma exosomes derived from ESRD patients (ESRD-Ex), renal transplant recipients (RTR-Ex), and the normal health control group (Nor-Ex) were isolated by ExoQuick-TC kit. Transmission electron microscopy and molecular size analysis were used to assess the morphology and size of exosomes. Alizarin Red S staining was carried out to detect calcification of vascular smooth muscle cells (VSMCs). Protein levels of Fetuin-A, matrix gla protein (MGP), Annexin-A2, bone morphogenetic protein (BMP-2), and receptor activator for nuclear factor-κ B ligand (Rankl) were measured by Western Blot analysis and the contents of that were detected using ELISA. Coronary artery calcification scores (CACS) were quantified via Agaston and analysed by Siemens CaScoring software. Results Compared with Nor-Ex, the ESRD-Ex promoted calcification of VSMCs significantly, and RTR-Ex could attenuate VSMCs calcification. Moreover, the protein concentration of ESRD-Ex was significantly higher than Nor-Ex and RTR-Ex, and the content of both MGP and Fetuin-A, the calcification inhibitors, were prominently lower in ESRD-Ex than those in Nor-Ex. The content of Annexin-A2, one of the calcification promoters, was significantly higher in ESRD-Ex and RTR-Ex than that in Nor-Ex. But, BMP-2 and Rankl had no significant difference among the three groups. In addition, the content of Fetuin-A in RTR-Ex was higher than that in ESRD-Ex, though it was still lower than in Nor-Ex. Furthermore, the content of both plasma Fetuin-A and MGP were negatively while that of Annexin-A2 was negatively correlated to CACS. Conclusions These results indicated that ESRD-Ex significantly promoted VSMCs calcification while renal transplantation could partially attenuate the effect of exosomes. Fetuin-A and MGP were decreased but Annexin-A2 was increased in ESRD-Ex, and renal transplantation could increase the level of Fetuin-A rather than MGP.

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Changes in left ventricular structure and function associated with renal transplantation: a systematic review and meta‐analysis

et al. 2021

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Aims This study aimed to examine if the cardiac changes associated with uraemic cardiomyopathy are reversed by renal transplantation. Methods and results MEDLINE, Embase, OpenGrey, and the Cochrane Library databases were searched from 1950 to March 2020. The primary outcome measure was left ventricular mass index. Secondary outcome measures included left ventricular dimensions and measures of diastolic and systolic function. Studies were included if they used any imaging modality both before and after successful renal transplantation. Data were analysed through meta-analysis approaches. Weight of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation system. Twenty-three studies used echocardiography, and three used cardiac magnetic resonance imaging as their imaging modality. The methodological quality of the evidence was generally poor. Four studies followed up control groups, two using cardiac magnetic resonance imaging and two using echocardiography. Meta-analysis of these studies indicated that there was no difference in left ventricular mass index between groups following transplantation {standardized mean difference À0.07 [95% confidence interval (CI) À0.41 to 0.26]; P = 0.67}. There was also no difference observed in left ventricular ejection fraction [mean difference 0.39% (95% CI À4.09% to 4.87%); P = 0.86] or left ventricular end-diastolic volume [standardized mean difference À0.24 (95% CI À0.94 to 0.45); P = 0.49]. Inconsistent reporting of changes in diastolic dysfunction did not allow for any meaningful analysis or interpretation. Conclusions The evidence does not support the notion that uraemic cardiomyopathy is reversible by renal transplantation. However, the evidence is limited by methodological weaknesses, which should be considered when interpreting these findings.

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Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies

Cited by 140 publications

References 135 publications

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Plasma exosomes derived from patients with end-stage renal disease and renal transplant recipients have different effects on vascular calcification

Changes in left ventricular structure and function associated with renal transplantation: a systematic review and meta‐analysis

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