Cardiovascular Disease and Kidney Disease Progression in Kidney Transplant Recipients.
transplant recipients have a high prevalence of cardiovascular disease (CVD) and CVD
risk factors. The relationship of CVD and CVD risk factors with kidney disease
progression in transplant recipients remains uncertain. We performed a post hoc analysis
of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial
cohort to assess the association of CVD ... read moreand CVD risk factors with kidney failure and
all-cause mortality in stable kidney transplant recipients. CVD was defined as prior
myocardial infarction, coronary, carotid or peripheral artery revascularization, stroke,
or aortic aneurysm repair. Unadjusted and multivariable adjusted Cox proportional
hazards models were used to explore the association of CVD history and risk factors with
development of ESRD and all-cause mortality. In 3,721 participants with complete data,
mean age was 52 years, 18% were black, and 37% women; median graft vintage was 4.0
(1.7-7.4) years, 58% received deceased donor kidneys and 20% had prior CVD. Mean
baseline eGFR was 48 +/-17 ml/min/1.73m2. There were 296 kidney failure events and 440
deaths, with 666 individuals having the composite of kidney failure or death. Following
adjustment, prior CVD was associated with a borderline significant increased risk of
kidney failure [HR=1.33 (95% CI 0.98-1.73)] and significantly increased risk of
all-cause mortality [HR=1.51 (1.23-1.85)] and the composite of kidney failure and death
[HR=1.32 (1.11 - 1.58)]. Other risk factors for kidney failure included black race,
higher SBP, lower HDL cholesterol, current smoking status as well as lower eGFR and
deceased donor transplant. In stable kidney transplant recipients, CVD and CVD risk
factors are associated with development of kidney failure; future trials should explore
CVD risk factor modification to slow kidney disease
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Andrew Levey, and Daniel Weiner.
Committee: Hocine Tighiouart.
Keyword: Health sciences.read less