Risk factors for cardiovascular disease in renal transplant recipients and strategies to minimize risk

Liefeldt, Lutz; Budde, Klemens

doi:10.1111/j.1432-2277.2010.01159.x

Cited by 106 publications

(78 citation statements)

References 125 publications

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“…CVD is an umbrellaterm which covers congestive cardiac failure (CCF), coronary artery disease (CAD), cerebrovascular disease and peripheral vascular disease. Rates of cardiac death in renal transplant recipients (RTRs) still remain higher than in the general population, with the rate of cardiac death 10times higher and the annual rate of fatal or nonfatal CV events 50times that of the general population [10] . Cardiac related disease accounts for 17% of all deaths in RTRs and in combination with cerebrovascular disease accounts for 22% of all deaths.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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“…Non-traditional risk factors such as homocysteine, uremia, left ventricular hypertrophy and graft dysfunction also have a significant role to play (21).There is a complex interplay between traditional and nontraditional risk factors causing CVD in kidney transplant patients. The strongest risk factor for cardiac risk is pre-existing CVD prior to transplant.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…This includes congestive heart failure, coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Renal transplant recipients have up to 10 times the rate of cardiac death and 50 times the annual rate of fatal or nonfatal cardiovascular events as the general population (21). Nearly 40% of patients have experienced a cardiovascular event at 36 months after renal transplantation, with congestive heart failure and myocardial infarction being the most common events (22,23)).…”

Section: Patient and Graft Survivalmentioning

confidence: 99%

Medical Management of the Kidney Transplant Recipient

Patel¹,

Lee²

2012

Current Concepts in Kidney Transplantation

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“…On the other hand, although the transplanted kidney provides cardiac and renal benefits, kidney function still remains poorer than that of healthy subjects. Renal transplant recipients have a much higher incidence of cardiac death and non-fatal cardiovascular events compared with the general population (Liefeldt and Budde 2010).…”

mentioning

confidence: 99%

Risk Factors Associated with Coronary Artery Calcification Should Be Examined before Kidney Transplantation

Simić-Ogrizović¹,

Bogavac-Stanojević

Vuckovic

et al. 2012

Tohoku J. Exp. Med.

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The best treatment for end stage renal disease (ESRD) patients is kidney transplantation, but the renal transplant recipients still have a higher incidence of cardiovascular events compared with general population. Cardiovascular risk factors were imposed long before ESRD, as the majority of patients starting dialysis or kidney transplantation already have signs of advanced atherosclerosis. Artery calcification is an organized, regulated process similar to bone formation. Coronary artery calcification (CAC) is found frequently in advanced atherosclerotic lesions and could be a useful marker of them. We evaluated the prevalence of CAC in 49 stable renal transplant recipients and in 48 age-and gender-matched patients with chronic kidney disease (CKD) in stages 2-5 not requiring dialysis to assess risk factors associated with CAC. Computed tomography was used for CAC detection and quantification (CAC score). The prevalence of CAC was 43.8% in transplant recipients and 16.7% in CKD patients (p < 0.001). Transplant recipients with CAC were significantly older and had longer duration of CKD and/or dialysis than recipients without CAC. In contrast, the serum levels of fetuin A (an inhibitor of vascular calcification) and albumin were significantly lower in CKD patients with CAC than those without CAC. During the observation period (30 months), 30 patients, including 23 CKD patients, began dialysis, and 4 transplant recipients and 2 CKD patients died. Independent predictors of mortality were age, serum amyloid A and the CAC score. In conclusion, the examination and prevention of risk factors associated with atherosclerosis should be started at the beginning of renal failure.

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Risk factors for cardiovascular disease in renal transplant recipients and strategies to minimize risk

Cited by 106 publications

References 125 publications

Cardiovascular risk factors following renal transplant

Cardiovascular risk factors following renal transplant

Medical Management of the Kidney Transplant Recipient

Risk Factors Associated with Coronary Artery Calcification Should Be Examined before Kidney Transplantation

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