Renal Dysfunction Is a Strong and Independent Risk Factor for Mortality and Cardiovascular Complications in Renal Transplantation

Abstract

Renal transplant recipients (RTR) have shortened life expectancy, primarily due to premature cardiovascular disease (CVD). Traditional CVD risk factors are highly prevalent. In addition, several non-traditional risk factors may contribute to the high risk. The aim of the study was to evaluate the effects of renal dysfunction on mortality and cardiovascular complications in 1052 placebo-treated patients of the Assessment of LEscol in Renal Transplantation (ALERT) trial. Follow-up was 5-6 years and endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke. The effects of serum creatinine at baseline on these endpoints were evaluated. Elevated serum creatinine in RTR was a strong and independent risk factor for MACE, cardiac, noncardiovascular, and all-cause mortality, but not for stroke or non-fatal MI alone. Serum creatinine was associated with increased mortality and MACE, independent of established CVD risk factors. Graft loss resulted in increased incidences of non-cardiovascular death, all-cause mortality, MACE and non-fatal MI. In conclusion, elevated serum creatinine is a strong risk factor for all-cause, non-cardiovascular and cardiac mortality, and MACE, independent of traditional risk factors, but not for stroke or non-fatal MI alone.

Survival analysis and associated factors to mortality of renal transplant recipients in a University Hospital in Maranhão

“…2 Com o aprimoramento da imunofarmacologia e do manejo clínico dos pacientes, observou-se, ao longo do tempo, redução da taxa de mortalidade após o TR, embora esta redução não se tenha acompanhado de mudanças nas causas de óbito dessa população: as doenças cardiovasculares (DCV) mantêm o status de principal causa de morte após o TR. 3 A prevalência de fatores de risco cardiovascular é alta entre receptores de TR; muitos apresentam DCV prévia, Diabetes Mellitus (DM), Hipertensão Arterial (HA) ou dislipidemia no momento do transplante, 4 o que confere a esses pacientes um risco anual de morte por DCV de 3,5% a 5%. 5 Infecções constituem importantes fatores de risco para a mortalidade de receptores de TR, que estão suscetíveis a grande variedade de patógenos, principalmente bacterianos, fúngicos e virais, como consequência da terapia imunossupressora.…”

Phase III Study of Belatacept Versus Cyclosporine in Kidney Transplants from Extended Criteria Donors (BENEFIT‐EXT Study)

“…Furthermore, kidneys from extended criteria donors are more susceptible to the adverse effects of calcineurin inhibitors (9). Impaired kidney function at 1 year is associated with reduced long-term graft survival (10)(11)(12) and is an independent cardiovascular risk factor (12). Immunosuppressive regimens that avoid the renal and nonrenal toxicities of calcineurin inhibitors may make extended criteria donor transplants more attractive, might improve long-term patient and graft survival and could enable more patients to benefit from transplantation (13).…”

Management of Cardiovascular Disease in Renal Transplant Recipients

“…Although renal replacement by transplantation can abrogate that effect (13), allograft dysfunction is still an important risk factor for all-cause and CV mortality (10,14). In addition, proteinuria itself is a risk factor for CVD.…”