Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation

Abstract

BackgroundMalnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.MethodsWe enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2–4, 6, 8–10).ResultsThe patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84–20.32 p = 0.003).ConclusionsThe presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

Correlations between geriatric nutritional risk index and peripheral artery disease in elderly coronary artery disease patients

“…Malnutrition and inflammation form a vicious cycle, leading to the development of atherosclerosis, and this subsequently increases cardiovascular mortality in various populations. 26,27 Our combined analysis showed that elderly CAD patients with both low GNRI and high CRP levels were at a 5.5-fold higher risk of PAD. These results suggest that assessments of both nutritional and inflammatory status are required to improve the identification of elderly CAD patients with a high risk of advanced atherosclerosis.…”

“…Recently, the concept of malnutrition–inflammation–atherosclerosis syndrome has been proposed. Malnutrition and inflammation form a vicious cycle, leading to the development of atherosclerosis, and this subsequently increases cardiovascular mortality in various populations . Our combined analysis showed that elderly CAD patients with both low GNRI and high CRP levels were at a 5.5‐fold higher risk of PAD.…”

Excesso de peso em portadores de doença renal crônica candidatos a transplante renal

“…Desigualdades no acesso ao transplante são comuns em todo o mundo e vários são os fatores causadores, entre eles estão características socioculturais, socioeconômicas, clínicas e geográficas 14,15 . Como um possível fator limitante para o Tx renal está o exame laboratorial conhecido como albumina sérica, sendo a albumina uma proteína de fase aguda negativa 16 . Estudos 17,18 têm mostrado que a hipoalbuminemia sérica pode ser interpretada como um marcador de desnutrição, comorbidades, inflamação e aterosclerose em pacientes com DRC.…”

Pilot cohort study on the potential role of TCF7L2 rs7903146 on ischemic heart disease among non‐diabetic kidney transplant recipients

“…Cardiovascular disease (CVD) is common in kidney transplant recipients (KTRs) and coronary artery disease (CAD) alone is an important cause of morbidity and mortality in this setting and it is characterized by unique inflammatory features . These are affected by both specific transplant‐related risk factors and previous exposure to uremic milieu .…”

“…These are affected by both specific transplant‐related risk factors and previous exposure to uremic milieu . As a consequence, the Framingham risk model underestimates CV risk in this population and a significant proportion of cardiac events actually occur in non‐diabetic patients without any traditional risk factor …”