Background: Kidney transplant recipients have a high prevalence of cardiovascular disease (CVD) and CVD risk factors, such that CVD is the leading cause of mortality. The relationship between CVD risk factors and kidney failure outcomes in transplant recipients remains uncertain.
Methods: We performed a post hoc analysis of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial cohort to assess the association of traditional CVD risk factors, including prior CVD defined as history of MI, coronary, carotid or peripheral artery revascularization, stroke, or aortic aneurysm repair, non-traditional risk factors, and transplant specific factors with kidney failure outcomes and all-cause mortality in kidney transplant recipients. 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.
Results: In 4,016 participants, mean age was 52 years, 18% were black, and 37% women; median graft vintage was 4.0 (1.7-7.5) years, 58% received deceased donor kidneys and 20% had prior CVD. Mean baseline eGFR was 48 +/-16 ml/min/1.73m2. In 3,419 participants with complete data, there were 296 kidney failure events and 439 deaths, with 665 individuals having the composite of kidney failure or death. Following adjustment, those with prior CVD events were at borderline significant increased risk of kidney failure [HR=1.30 (95% CI 0.98-1.73)] and significantly increased risk of all-cause mortality [HR=1.50 (1.22-1.84)] and the composite of kidney failure and death [HR=1.31 (1.10 1.56)].Other risk factors for kidney failure included black race, higher SBP, lower HDL cholesterol, and current smoking status as well non-traditional risk factors including lower eGFR and deceased donor transplant.
Conclusion: In stable kidney transplant recipients, a history of CVD and CVD risk factors are associated with development of kidney failure; future studies addressing kidney function loss in transplant recipients should explore CVD risk factor modification.
Levey, A.: Grant/Research Support, NIDDK for FAVORIT.
To cite this abstract in AMA style:John A, Weiner D, Carpenter M, Hunsicker L, Kusek J, Pfeffer M, Solomon S, Weir M, Levey A. Cardiovascular Disease and Kidney Disease Progression in Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/cardiovascular-disease-and-kidney-disease-progression-in-kidney-transplant-recipients/. Accessed May 28, 2020.
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