Cardiovascular disease and kidney disease progression in kidney transplant recipients.

摘要

Kidney 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 and 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/1.73m 2. 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 progression.