Impact of cardiovascular risk stratification strategies in kidney transplantation over time

Abstract

Background Kidney transplant recipients exhibit a dramatically increased cardiovascular (CV) risk. In 2007, Austrian centres implemented a consensus of comprehensive CV screening programme prior to kidney transplantation (KT). The consensus placed a particular emphasis on screening for coronary artery disease (CAD) with cardiac computed tomography (CT) or coronary angiography (CAG) in patients with diabetes mellitus, known CAD or those having multiple conventional CV risk factors. Here, we investigate if this affected risk stratification and post-transplant CV outcomes. Methods In a retrospective chart review, we evaluated 551 KTs performed from 2003 to 2015 in our centre. Patients were categorized into three groups: KT before (2003–07), directly after (2008–11) and 5 years after (2012–15) implementation of the consensus. We analysed clinical characteristics, the rate of cardiac CTs and CAGs prior to KT as well as major adverse cardiac events (MACEs) during a 2-year follow-up after KT. Results The three study groups showed a homogeneous distribution of comorbidities and age. Significantly more cardiac CTs (13.6% versus 10.2% versus 44.8%; P = 0.002) and CAGs (39.6% versus 43.9% versus 56.2%; P = 0.003) were performed after the consensus. Coronary interventions were performed during 42 out of 260 CAGs (16.2%), the cumulative 2-year MACE incidence was 8.7%. Regarding MACE occurrence, no significant difference between the three groups was found. Conclusion CV risk stratification has become more rigorous and invasive after the implementation of the consensus; however, this was not associated with an improvement in CV outcome.

Hypomagnesemia Is a Risk Factor for Infections after Kidney Transplantation: A Retrospective Cohort Analysis

“…We conducted a single-center retrospective cohort study of 376 consecutive KTRs transplanted at the Transplant Center Graz (Medical University of Graz) from 1 January 2005 to 31 December 2015. Patients with concomitant serum Mg 2+ and 25(OH)-vitamin D measurement within three months after KT were identified using our database as published previously ( Figure 1 ) [ 20 ].…”

“…All data were derived retrospectively from the KT and electronic medical records of our center and the Austria Dialysis and Transplantation Registry (OEDTR), as stated previously [ 20 ]. The date of KT (index date) was registered for the calculation of time to outcome event.…”

“…The date of KT (index date) was registered for the calculation of time to outcome event. As stated previously, in more than 98% of cases, the ethnicity of the patients was Caucasian, representing the Austrian ethnical background, and was not further specified [ 20 ].…”

Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal?

“…Although there are no other RCTs examining whether more screening for asymptomatic coronary artery disease in prospective KTR improves survival or reduces CV events after transplantation, two important observational studies have reported recently. An intensive CV risk stratification protocol implemented nationwide in Austria in 2007 resulted in over 50% of transplanted patients having a coronary angiogram but failed to demonstrate any improvement in patient survival or a reduction in coronary events in patients transplanted directly after (2008–11) or 5 years after (2012–15) compared with historical data (2003–07) [ 31 , 33 ]. A prospective study of 2572 UK KTR who received a transplant in 2011–17 in 18 centres found that 51% underwent cardiac screening pre-transplantation with screening by centre varying from 5% to 100% [ 32 ].…”

“…This is more than a theoretical consideration. For example, during the implementation of a ‘stricter’ CV screening process in Austria, the median age and prevalence of comorbidities of KTRs in that country were unchanged over a 13-year observation period [ 31 ]. Elsewhere, international trends were those of an ageing KTR population [ 70–74 ].…”