Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients

Benguzzi, M; Mansell, Holly; Hassan, Alaa Ali; Elmoselhi, Hamdi; Mainra, Rahul; Shoker, Ahmed

doi:10.1111/ctr.12466

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…The validated CV risk calculator for RTR uses 7 variables – age, history of ischemic heart disease, diabetes mellitus, serum creatinine, LDL cholesterol level, number of previous transplants, and smoking status [8, 9]. When compared to the Framingham risk score, it was more accurate in risk prediction of major cardiovascular events in RTR, mostly due to the addition of GFR to traditional risk factors [10]. An additional problem contributing to the CV risk in RTR are functioning AVF [11].…”

Section: Discussionmentioning

confidence: 99%

Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

2020

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Background: Data on the cardiorenal syndrome (CRS) in renal transplant recipients (RTR) are scarce. We investigated the prevalence, clinical presentation, treatment, and outcomes of patients with CRS in our renal transplant cohort. Methods: Charts and medical records of adult RTR were investigated to identify patients with renal allograft dysfunction and heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Results: From December 2009 to December 2019, a total of 1,610 patients received a kidney allograft at our institution. CRS was diagnosed in 9 patients (0.56%) a median of 11 years after transplantation (4-20 years). Seven of the patients were male, and 2 were female. The median age when CRS was diagnosed was 71 years (64-80 years). The major presenting symptom was dyspnea. Five patients had HFrEF, and 4 had HFpEF. The patient's median basal creatinine clearance was 37 mL/ min (range 29-77 mL/min). At hospitalization, it was decreased to 24 mL/min (range 13-45 mL/min). The patients were treated with diuretics, but 5 of them required extracorporeal fluid removal. At the 16-month follow-up (median), all patients with HFpEF were alive and had returned to initial levels of creatinine clearance. Two of the 5 HFrEF had died, and 2 needed permanent extracorporeal water removal. Conclusion: CRS after renal transplantation was rare (< 1.0%), but CRS in HFreF patients was associated with a poor outcome.

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Section: Discussionmentioning

confidence: 99%

Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

2020

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“…These studies demonstrated that the risk score appropriately identifies recipients at low-risk. However, it greatly underestimates cardiovascular risk in recipients at moderate and high-risk [ 68 – 71 ]. Therefore, recipients in most need of effective preventative strategies may be overlooked.…”

Section: Predicting Cardiovascular Riskmentioning

confidence: 99%

“…When compared to Framingham risk score, the CRCRTR-MACE more accurately predicted the risk of cardiovascular events in RTR. The improvement in risk prediction with CRCRTR-MACE appears to be primarily related to the addition of GFR to traditional risk factors [ 68 ].…”

Section: Predicting Cardiovascular Riskmentioning

confidence: 99%

Cardiovascular risk in renal transplant recipients

2018

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Successful kidney transplantation offers patients with end-stage renal disease the greatest likelihood of survival. However, cardiovascular disease poses a major threat to both graft and patient survival in this cohort. Transplant recipients are unique in their accumulation of a wide range of traditional and non-traditional cardiovascular risk factors. Hypertension, diabetes, dyslipidaemia and obesity are highly prevalent in patients with end-stage renal disease. These risk factors persist following transplantation and are often exacerbated by the drugs used for immunosuppression in organ transplantation. Additional transplant-specific factors such as poor graft function and proteinuria are also associated with increased cardiovascular risk. However, these transplant-related factors remain unaccounted for in current cardiovascular risk prediction models, making it challenging to identify transplant recipients with highest risk. With few interventional trials in this area specific to transplant recipients, strategies to reduce cardiovascular risk are largely extrapolated from other populations. Aggressive management of traditional cardiovascular risk factors remains the cornerstone of prevention, though there is also a potential role for selecting immunosuppression regimens to minimise additional cardiovascular injury. Electronic supplementary material The online version of this article (10.1007/s40620-018-0549-4) contains supplementary material, which is available to authorized users.

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Current state of clinical end-points assessment in transplant: Key points

Hernández

Muriel

Abraira

2016

Transplantation Reviews

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Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients

Abstract: CRCRTR-MACE identified more patients at high cardiovascular risk, even in those with more favorable renal function, suggesting a fundamental difference between the two calculators beyond renal function.

Cited by 3 publications

References 24 publications

Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

Cardiovascular risk in renal transplant recipients

Current state of clinical end-points assessment in transplant: Key points

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