Fp747time on Dialysis as an Independent Risk Factor for Cardiovascular Events Before and After Kidney Transplantation
Year: 2018
Type: conference-abstract
Abstract: INTRODUCTION AND AIMS: End-stage renal disease (ESRD) increases cardiovascular (CV) event rate and is associated with mortality risk. We aimed to analyze the importance of time in dialysis as an independent risk factor for CV events before and after kidney transplantation (KT), compared with conventional risk factors such as diabetes mellitus, smoking, hypertension, hyperlipidaemia or obesity and mineral bone disorder. METHODS: The study included all patients assessed for KT between July, 2011 and September, 2017. Demographic, clinical and biochemical data were recorded. CV events included acute coronary syndromes (ACS), heart failure (HF) and arrhythmias as well as procedures during follow up. Mineral and bone disorder was defined as serum iPTH levels ≥ 500 pg/ml (iPTH>500), and hyperlipidaemia in patients with total cholesterol ≥ 250 mg/dl, LDL-cholesterol ≥ 100 mg/dl or triglycerides ≥ 150 mg/dl. Isolated KT and combined kidney-liver or kidney-pancreas transplants were considered for analysis. Results are expressed as mean ± standard deviation or median and interquartile range, and proportion as appropriate. Categorical variables were analized by means of X2 with odds ratio calculation. Two tails alfa= 0.05 was considered statistically significant. Multivariate logistic regression analysis was performed for pre and post KT event prediction. RESULTS: A total of 923 patients were included in the study; 59% were males, aged 50±15 years old. History of conventional risk factors such as hypertension in 79%, diabetes mellitus in 19%, hyperlipidaemia in 71% and smoking in 30% were found; while 48.7% had iPTH>500 and 47% previous cardiac disease. KT was performed in 50.3% of assessed patients during follow-up, in 3.1% on a preemptive basis. Time on dialysis ≥ 5 years was strongly associated with increased CV events risk during follow-up (pre-KT 23 vs.13.3%, OR 1.94, 95%CI 1.13-3.31; p= 0.012; and post-KT 34 vs.13%, OR 3.4; 95%CI 1.64-7.32; p= 0.001). Serum iPTH levels > 500 pg/ml were associated with revascularization in pre-KT period (17.4 vs. 9.2%; OR 2.1; 95%CI 1.05-4.17; p=0.03). There was no association among pre-KT CV events and conventional risk factors (p=0.30), hyperlipidaemia (p=0.88) or iPTH>500 (p=0.51). Conventional risk factors (p=0.72), hyperlipidaemia (p=0.86) and iPTH>500 (p=0.82) were not related with post-KT CV events. After multivariate logistic regression analysis, previous cardiac disease was the only independent predictor for pre-KT CV events (OR 2.57; 95%CI 1.10-6.05; p= 0.03). Previous cardiac disease and dialysis period ≥ 5 years were both independent predictors for CV events after KT (OR 5.95; 95%CI 1.72-20.5; p=0.005 and OR 4.42; 95%CI 1.32-14.8; p=0.02, respectively). CONCLUSIONS: Cardiac disease is the major cause of hospitalizations and death in patients with ESRD. Time on dialysis is a more important contributor to the excess of cardiovascular disease than conventional risk factors or mineral and bone disorder in this setting. Strategies to reduce on dialysis time should be implemented to get better cardiovascular outcomes after transplantation.
Institution: Favaloro Foundation
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2804433779