Subclinical atherosclerosis and related risk factors in renal transplant recipients

Abstract

Long-term survival after successful renal transplantation is shortened by cardiovascular disease. Cardiovascular disease is a main cause of morbidity and death among children and young adults after renal transplantation. The aim of our study was to measure the carotid intima media thickness (cIMT) and determine its relationship to the risk factors for early arteriopathy in renal transplant recipients. Sixty-six stable renal transplant patients (36 female and 30 male), 7-25 years of age (mean 18.3 +/- 4.5 years) were enrolled in this study. The cIMT was measured by high-resolution B mode ultrasonography in multiple projections. The results were correlated with clinical and paraclinical parameters, including age, gender, body mass index (BMI), blood pressure, glomerular filtration rate (GFR), duration of dialysis, duration of chronic kidney disease (CKD), post-transplantation interval, calcium-phosphate (CaxP) product, cumulative dose of Ca-based P binder and calcitriol, lipid profile, uric acid, and cyclosporine level. The mean post-transplantation follow-up period was 64 +/- 40 months. The mean cIMT standard deviation score (SDS) of the patients and the control group was 0.60 +/- 0.81 mm (range -1.10 mm to 2.75 mm) and -1.25 +/- 0.95 mm (range -3.23 mm to 0.26 mm), respectively. Renal transplant recipients had a significantly greater cIMT than that of the controls (P < 0.001). Among several risk factors, there were positive correlations between cIMT SDS and gender, and cumulative dose of calcitriol (P = 0.02 and P = 0.02, respectively). In conclusion, subclinical atherosclerosis is present in young transplant recipients. Non-invasive monitoring of cIMT in renal transplant patients for the detection of early vascular lesions might be of value in preventing cardiovascular disease. Further studies are needed to see if proper monitoring of vitamin D therapy before and after transplantation could be helpful in the prevention of arteriopathy in renal transplant recipients.

Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies

“…All kinds of patient groups, compared with the control groups, showed an increased cIMT, as in other studies performed in children and young adults after transplantation [11,14,70], or in predialyzed and dialyzed [69,82]. This confirmed that vascular abnormalities are already present in children and adolescents with CRF.…”

Cardiovascular Risk 10 Years After Liver Transplant

“…36 In young renal transplant recipients, noninvasive monitoring of carotid intimamedia thickness is useful in detecting early vascular lesions and may represent a cardiovascular risk. 37,38 In conclusion, our results suggest that the absolute 10-year risk of fatal cardiovascular events according to SCORE is relatively low in long-term (10 years) liver transplant survivors, even when the majority of these patients had 1 or more cardiovascular risk factors. Active medical follow-up, early treatment before complication and the relatively young age of our population could explain this paradox.…”

Clinical practice

“…Although major cardiovascular events are rare in children, left ventricular hypertrophy and subclinical atherosclerosis are often present even in young kidney transplant recipients [13,97]. Several observational studies in adults suggest that increased FGF23 is independently associated with mortality, left ventricular hypertrophy, endothelial dysfunction, and atherosclerosis in patients with high or even normal serum phosphate levels [42,64,65].…”