Cardiovascular risk factors following renal transplant

Abstract

Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

Carotid Revascularization in Asymptomatic Patients after Renal Transplantation

“…16,17 While there have been many studies of subjects with renal insufficiency and those on dialysis, outcomes following carotid revascularization in renal transplant patients remain unknown. Compared with CKD subjects who have excess periprocedural risk that could negate the effects of carotid revascularization and who may not live long enough to derive stroke prevention benefit, the renal transplant population may be one to benefit from CEA or stenting.…”

First experience of cadaveric renal transplantation in Sri Lanka

“…Risk factors for CVD include hypertension, dyslipidemia, posttransplant diabetes, inflammation and anaemia [14][15][16][17][18]. The developed world has overcome the cyclosporine era where infections and malignancies were the common cause of death [12].…”

Role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant recipients

“…It alone accounts for 35-50% of allcause mortality in this unique population. 1 Occurrence of cardiovascular events in renal transplant patient is multifactorial (multiple traditional and non-traditional factors) in origin. Elevated homocysteine levels were independently associated with CV events and mortality in stable RTRs, although its mechanism is not fully understood.…”