Clinical impact of preexisting vascular calcifications on mortality after renal transplantation

Hernández, Domingo; Rufino, Margarita; Bartolomei, Sergio; González-Rinne, Ana; Lorenzo, V.; Cobo, Marian; Torres, Armando

doi:10.1111/j.1523-1755.2005.00303.x

Cited by 81 publications

(63 citation statements)

References 26 publications

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“…Compared with the general population, KTRs are at a 3-to 5-fold higher risk (2), with some improvement in recent years (3). Calcification of the arterial wall is a strong cardiovascular risk factor in the general population (4-7), in patients on dialysis (8) and in KTRs (9,10). Arterial calcification is seen with aging and is known to proceed faster in patients with kidney disease (11)(12)(13), affecting >80% of KTRs (14).…”

Section: Introductionmentioning

confidence: 99%

“…In aqueous solution, calcium and phosphate on supersaturation form amorphous nanoscale aggregates (Ca 6 [PO 4 ] 4 ), which are rapidly transformed to hydroxyapatite (Ca 10 [PO 4 ] 6 [OH] 2 ) (19,20). This mineral represents the main constituent of physiological (bone and teeth) and pathological (soft tissues and vasculature) calcifications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Dahle

Åsberg

Hartmann

et al. 2016

American Journal of Transplantation

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Dahle

Åsberg

Hartmann

et al. 2016

American Journal of Transplantation

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“…Vascular calcification progresses substantially even in stable RTR and is an established predictor of morbidity and mortality. [3][4][5] The so-called traditional risk factors tobacco use, diabetes, obesity, hypertension, and dyslipidemia (i.e., the Framingham risk factors) have been identified as independent predictors of cardiovascular disease after kidney transplantation. 6 Biomineralization is a tightly regulated and location-specific process, determined by both inhibitors and promoters of calcification.…”

mentioning

confidence: 99%

Calcification Propensity and Survival among Renal Transplant Recipients

Keyzer

Borst

Berg

et al. 2016

Journal of the American Society of Nephrology

118

108

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Calciprotein particle maturation time (T 50 ) in serum is a novel measure of individual blood calcification propensity. To determine the clinical relevance of T 50 in renal transplantation, baseline serum T 50 was measured in a longitudinal cohort of 699 stable renal transplant recipients and the associations of T 50 with mortality and graft failure were analyzed over a median follow-up of 3.1 years. Predictive value of T 50 was assessed for patient survival with reference to traditional (Framingham) risk factors and the calcium-phosphate product. Serum magnesium, bicarbonate, albumin, and phosphate levels were the main determinants of T 50 , which was independent of renal function and dialysis vintage before transplant. During follow-up, 81 (12%) patients died, of which 38 (47%) died from cardiovascular causes. Furthermore, 45 (6%) patients developed graft failure. In fully adjusted models, lower T 50 values were independently associated with increased all-cause mortality (hazard ratio, 1.43; 95% confidence interval, 1.11 to 1.85; P=0.006 per SD decrease) and increased cardiovascular mortality (hazard ratio, 1.55; 95% confidence interval, 1.04 to 2.29; P=0.03 per SD decrease). In addition to age, sex, and eGFR, T 50 improved prognostication for all-cause mortality, whereas traditional risk factors or calcium-phosphate product did not. Lower T 50 was also associated with increased graft failure risk. The associations of T 50 with mortality and graft failure were confirmed in an independent replication cohort. In conclusion, reduced serum T 50 was associated with increased risk of all-cause mortality, cardiovascular mortality, and graft failure and, of all tested parameters, displayed the strongest association with all-cause mortality in these transplant recipients.

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“…At the time of renal transplantation the majority of ESRD patients already have an enormous burden of cardiovascular disease. Hernandez et al (2005) found pre-existing vascular calcification to be an independent predictor of cardiovascular and all-cause mortality following transplantation. Relapse of pre-existing or appearance new risk factors in the post-transplantation period result, in part, from the atherogenic potential of immunosuppressive drugs (Ojo 2006).…”

Section: Discussionmentioning

confidence: 94%

Risk Factors Associated with Coronary Artery Calcification Should Be Examined before Kidney Transplantation

Simić-Ogrizović¹,

Bogavac-Stanojević

Vuckovic

et al. 2012

Tohoku J. Exp. Med.

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The best treatment for end stage renal disease (ESRD) patients is kidney transplantation, but the renal transplant recipients still have a higher incidence of cardiovascular events compared with general population. Cardiovascular risk factors were imposed long before ESRD, as the majority of patients starting dialysis or kidney transplantation already have signs of advanced atherosclerosis. Artery calcification is an organized, regulated process similar to bone formation. Coronary artery calcification (CAC) is found frequently in advanced atherosclerotic lesions and could be a useful marker of them. We evaluated the prevalence of CAC in 49 stable renal transplant recipients and in 48 age-and gender-matched patients with chronic kidney disease (CKD) in stages 2-5 not requiring dialysis to assess risk factors associated with CAC. Computed tomography was used for CAC detection and quantification (CAC score). The prevalence of CAC was 43.8% in transplant recipients and 16.7% in CKD patients (p < 0.001). Transplant recipients with CAC were significantly older and had longer duration of CKD and/or dialysis than recipients without CAC. In contrast, the serum levels of fetuin A (an inhibitor of vascular calcification) and albumin were significantly lower in CKD patients with CAC than those without CAC. During the observation period (30 months), 30 patients, including 23 CKD patients, began dialysis, and 4 transplant recipients and 2 CKD patients died. Independent predictors of mortality were age, serum amyloid A and the CAC score. In conclusion, the examination and prevention of risk factors associated with atherosclerosis should be started at the beginning of renal failure.

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Clinical impact of preexisting vascular calcifications on mortality after renal transplantation

Abstract: VC evaluated by a simple and inexpensive plain radiography are an independent predictor of cardiovascular and all-cause mortality following RT. This finding may encourage the implementation of appropriate therapeutic strategies after RT.

Cited by 81 publications

References 26 publications

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Calcification Propensity and Survival among Renal Transplant Recipients

Risk Factors Associated with Coronary Artery Calcification Should Be Examined before Kidney Transplantation

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