Introduction: Proteinuria is a risk factor for cardiovascular (CV) disease in the general population and occurs commonly after kidney transplantation. The association between proteinuria and CV disease in this population has not been sufficiently evaluated, and it is not clear whether proteinuria reduction affects CVD disease risk. In this study we sought to evaluate the association between time varying proteinuria and the change in proteinuria over time and major adverse cardiovascular events (MACE) after kidney transplantation.

Patients and methods: we collected the routine dipstick urine protein evaluation results performed every three to six months in all patients at our post transplantation follow-up clinic. The follow-up time was divided into 6 months intervals and proteinuria was evaluated by using all available protein measurements during each interval. Urine protein concentration was defined as negative or positive according to the mean value during the six month interval. The primary outcome was MACE defined as: CV death, non-fatal myocardial infraction, hospitalization due to unstable angina, need for coronary revascularization, non-fatal stroke and peripheral vascular disease related hospitalization or revascularization. Time dependent Cox proportional hazard model was used using univariate and multivariate adjusted analysis.

Results: five hundred and eighty patients transplanted between 2005 and 2013 had 150 CV events during median follow-up of 3.35 years (interquartile range 2.21-5.81). Time varying proteinuria was associated with an increased risk of MACE (hazard ratio (HR) 2.44, 95% confidence interval (CI) 1.72-3.45) and (HR 2.31, 95 CI 1.59-3.35) for univariate and multivariate adjusted analysis respectively. The effect was observed even in low grade proteinuria and the degree of proteinuria did increase risk significantly. Regression of proteinuria to normal values was associated with risk reduction to a non-significant level (HR 1.57, 95 CI 0.88-2.79).

Discussion: Even modest proteinuria is associated with increased CV disease risk in patients after kidney transplantation. Primary and secondary prevention measures should be employed in patients with for risk reduction. Treatment aimed for reduction of proteinuria to normal levels might be beneficial.

CITATION INFORMATION: Rahamimov R., Molcho M., Vahav I., Chagnac A., Mor E., Rozen-Zvi B. Proteinuria is Associated with Increased Risk for Cardiovascular Disease after Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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