De novo major cardiovascular events in kidney transplant recipients: a comparative matched cohort study

Abstract

Background Although cardiovascular disease is known to be one of the leading causes of death after kidney transplantation (KT), evidence on the risk difference of de novo major adverse cardiovascular event (MACE) in kidney transplant recipients (KTRs) compared to that in dialysis patients or the general population (GP) remains rare. Methods We identified KTRs using the nationwide health insurance database in South Korea and then 1:1 matched them with the dialysis and GP controls without pre-existing MACE. The primary endpoint was defined as de novo MACEs consisted of myocardial infarction, coronary revascularization, and ischemic stroke. The secondary endpoint was all-cause mortality and death-censored graft failure (DCGF) in KTRs. Results We included 4156 individuals in every three groups and followed up them for 4.7 years. De novo MACEs occurred in 3.7, 21.7, and 2.5 individuals per 1000 person-years in the KTRs, dialysis controls, and GP controls, respectively. KTRs showed a lower MACE risk (adjusted hazard ratio (aHR) 0.16, 95% confidence interval (CI) 0.12–0.20, p < 0.001) than dialysis controls, whereas a similar to GP controls (aHR 0.81, 95% CI 0.52–1.27, p = 0.365). In addition, KTRs showed similar MACE risk compared to GP groups, regardless of age, sex, the presence of comorbidities including hypertension, diabetes, and dyslipidemia. Among KTRs, de novo MACE was associated with an increased risk of all-cause mortality, but not with DCGF. Conclusions De novo MACE in KTRs was much lower than dialysis patients and even similar risk to the GP, while once it occurred it affected elevated mortality risk in KTRs.

Risk Prediction In Long Term Kidney Transplant Recipients – Model Development Using Apelinergic Markers And Machine Learning Tools

“…For mortality and kidney allograft loss, the median (IQR) follow-up time was 82.6 (42.1, 85.2) months. Most patients retained adequate kidney function at baseline, with mean eGFR upon presentation at 58.4 (22.6) ml/1.73m 2 /min, respectively.…”

“…This was a cohort of middle-aged adults, with mean (SD) age of 50.8 (14.5) years, and male predominance (N=72, 70.6%). Most patients were overweight, with mean (SD) body mass of 26.1 (4.68) kg/m 2 . Tacrolimus-based triple therapy regimens were most commonly utilized (N=67, 66.3%), followed by cyclosporine-based (N=22, 21.6%).…”

“…Comparison across groups is performed using Welch’s t test (supplemented with permutation based testing) for continuous variables. The measure of association for two dichotomous variables was assessed with x 2 test or Fisher’s exact test.…”

“…Cardiovascular (CV) disease remains one of the leading causes of death across the whole spectrum of CKD. CV-related mortality is starkly elevated in end-stage CKD, especially in subjects requiring renal replacement therapy (RRT), but also remains significantly elevated after kidney transplant (KTx) 2 .…”

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

“…Epidemiological information on CVD in kidney transplant recipients (KTRs) has relied mainly on registry databases and retrospective studies, whereas only recently prospective studies have been added [ 47–50 ]. Although CV risk is reduced following kidney transplantation compared with dialysis, the incidence of CVD in KTRs is three to five times higher than in the general population [ 47 , 48 ] and CVD remains the principal cause of death, accounting for 20–35% of overall mortality [ 50–52 ].…”