Assessment of Arterial Stiffness, Volume, and Nutritional Status in Stable Renal Transplant Recipients

Lukasz Czyzewski, Janusz Wyzgal, Emilia Czyzewska, Andrzej Kurowski, Janusz Sierdzinski, Zenon Truszewski, Lukasz Szarpak, Lukasz Czyzewski, Janusz Wyzgal, Emilia Czyzewska, Andrzej Kurowski, Janusz Sierdzinski, Zenon Truszewski, Lukasz Szarpak

Abstract

Reduction of cardiovascular death might have a significant effect on the long-term survival rates of renal transplant recipients (RTRs). The aim of the study was to assess the relation between arterial stiffness and graft function, adipose tissue content, and hydration status in patients after kidney transplantation (KTx).The study included 83 RTR patients (mean age: 55 ± 13 years) who had been admitted to a nephrology-transplantation outpatient clinic 0.5 to 24 years after KTx. Clinical and laboratory data were analyzed and eGFR was calculated with the CKD-EPI formula. Arterial stiffness was assessed in all RTRs with pulse wave propagation velocity (PWV) with the use of a complior device. In addition, fluid and nutritional status was assessed with a Tanita BC 418 body composition analyzer. The control group consisted of 31 hospital workers who received no medication and had no history of cardiovascular disease.Multivariable linear regression analysis, with PWV as a dependent variable, retained the following independent predictors in the final regression model: red blood cell distribution width (RDW) (B = 0.323; P = 0.004), age (B = 0.297; P = 0.005), tacrolimus therapy (B = -0.286; P = 0.004), and central DBP (B = 0.185; P = 0.041). Multivariable linear regression analysis with eGFR as a dependent variable retained the following independent predictors in the final regression model; creatinine concentration (B = -0.632; P = 0.000), hemoglobin (B = 0.280; P = 0.000), CRP (B = -0.172; P = 0.011), tacrolimus therapy (B = 0.142; P = 0.039), and triglycerides (B = -0.142; P = 0.035).Our data indicates that: kidney transplant recipients can present modifiable CVD risk factors linked to increased arterial stiffness, DBP, waist circumference, SCr, time on dialysis, CyA therapy, and visceral fat mass; RDW is a parameter associated with arterial stiffness; and parameters such as CyA therapy, time on dialysis, PWV, RDW, and triglycerides show negative associations with the allograft function assessed with eGFR.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Simple linear regression analysis (Pearson) between pulse wave velocity and red blood cell distribution width.

References

    1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341:1725–1730.
    1. Collins AJ, Foley RN, Chavers B, et al. 2013 USRDS Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Am J Kidney Dis 2014; 63:e283–e294.
    1. Dahle DO, Eide IA, Åsberg A, et al. Aortic stiffness in a mortality risk calculator for kidney transplant recipients. Transplantation 2015; 99:1730–1737.
    1. Aakhus S, Dahl K, Widerøe TE. Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-yr. Clin Transplant 2004; 18:596–604.
    1. Boutouyrie P, Fliser D, Goldsmith D, et al. Assessment of arterial stiffness for clinical and epidemiological studies: methodological considerations for validation and entry into the European Renal and Cardiovascular Medicine registry. Nephrol Dial Transplant 2014; 29:232–239.
    1. Ferro CJ, Savage T, Pinder SJ, et al. Central aortic pressure augmentation in stable renal transplant recipients. Kidney Int 2002; 62:166–171.
    1. Bahous SA, Stephan A, Barakat W, et al. Aortic pulse wave velocity in renal transplant patients. Kidney Int 2004; 66:1486–1492.
    1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159–2219.
    1. Ignace S, Utescu MS, De Serres SA, et al. Age-related and blood pressure–independent reduction in aortic stiffness after kidney transplantation. J Hypertens 2011; 29:130–136.
    1. Westhoff TH, Straub-Hohenbleicher H, Basdorf M, et al. Time-dependent effects of cadaveric renal transplantation on arterial compliance in patients with end-stage renal disease. Transplantation 2006; 81:1410–1414.
    1. Birdwell KA, Jaffe G, Bian A, et al. Assessment of arterial stiffness using pulse wave velocity in tacrolimus users the first year post kidney transplantation: a prospective cohort study. BMC Nephrol 2015; 16:93–99.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3:1–150.
    1. Inker LA, Levey AS. Pro: estimating GFR using the chronic kidney disease epidemiology collaboration (CKD–EPI) 2009 creatinine equation: the time for change is now. Nephrol Dial Transplant 2013; 28:1390–1396.
    1. Davidson J, Wilkinson A, Dantal J, et al. New-onset diabetes after transplantation: 2003 International consensus guidelines Proceedings of an international expert panel meeting Barcelona, Spain, 19 February 2003. Transplantation 2003; 75 (10 Suppl):S3–S24.
    1. Seibert FS, Behrendt C, Pagonas N, et al. Prediction of cardiovascular events after renal transplantation. Transplant Proc 2015; 47:388–393.
    1. Tonelli M, Sacks F, Arnold M, et al. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 2008; 117:163–168.
    1. Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009; 158:659–666.
    1. Lippi G, Targher G, Montagnana M, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Invest 2008; 68:745–748.
    1. Schouten F, Twisk JW, de Boer MR, et al. Increases in central fat mass and decreases in peripheral fat mass are associated with accelerated arterial stiffening in healthy adults: the Amsterdam Growth and Health Longitudinal Study. Am J Clin Nutr 2011; 94:40–48.
    1. Wizemann V, Wabel P, Chamney P, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009; 24:1574–1579.
    1. Czyżewski L, Sańko-Resmer J, Wyzgał J, et al. Comparative analysis of hypertension and its causes among renal replacement therapy patients. Ann Transplant 2014; 19:556–568.
    1. Pischon T, Sharma AM. Obesity as a risk factor in renal transplant patients. Nephrol Dial Transplant 2001; 16:14–17.
    1. Tutal E, Sezer S, Uyar ME, et al. Evaluation of nutritional status in renal transplant recipients in accordance with changes in graft function. Transplant Proc 2013; 45:1418–1422.
    1. Nicoletto BB, Fonseca NK, Manfro RC, et al. Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis. Transplantation 2014; 98:167–176.
    1. Djukanović L, Lezaić V, Blagojević R, et al. Co-morbidity and kidney graft failure-two main causes of malnutrition in kidney transplant patients. Nephrol Dial Transplant 2003; 18 Suppl 5:v68–v70.
    1. Sezer S, Gurlek Demirci B, Guliyev O, et al. Graft function and arterial stiffness: can bioimpedance analysis be useful in renal transplant recipients? Transplant Proc 2015; 47:1182–1185.
    1. Saxena A, Sharma RK. Hypertension in post-renal transplant patients: pilot study. Saudi J Kidney Dis Transpl 2014; 25:22–28.
    1. Hornum M, Clausen P, Idorn T, et al. Kidney transplantation improves arterial function measured by pulse wave analysis and endothelium-independent dilatation in uraemic patients despite deterioration of glucose metabolism. Nephrol Dial Transplant 2011; 26:2370–2377.
    1. Cohen DL, Warburton KM, Warren G, et al. Pulse wave analysis to assess vascular compliance changes in stable renal transplant recipients. Am J Hypertens 2004; 17:209–212.
    1. Stróżecki P1, Adamowicz A, Włodarczyk Z, et al. The influence of calcineurin inhibitors on pulse wave velocity in renal transplant recipients. Ren Fail 2007; 29:679–684.
    1. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003; 3:178–185.
    1. Opazo Saez A, Kos M, Witzke O, et al. Effect of new-onset diabetes mellitus on arterial stiffness in renal transplantation. Transpl Int 2008; 21:930–935.
    1. Nürnberger J, Dammer S, Opazo Saez A, et al. Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males. J Hum Hypertens 2003; 17:153–158.
    1. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27:2588–2605.
    1. Kneifel M, Scholze A, Burkert A, et al. Impaired renal allograft function is associated with increased arterial stiffness in renal transplant recipients. Am J Transplant 2006; 6:1624–1630.
    1. Muth BL, Astor BC, Turk J, et al. Outpatient management of delayed graft function is associated with reduced length of stay without an increase in adverse events. Am J Transplant 2015; doi: 10.1111/ajt.13689. (Accepted Article).
    1. Nankivell BJ, Borrows RJ, Fung CL, et al. The natural history of chronic allograft nephropathy. N Engl J Med 2003; 349:2326–2333.
    1. Kaplan B, Schold JD, Meier–Kriesche HU. Long–term graft survival with neoral and tacrolimus: a paired kidney analysis. J Am Soc Nephrol 2003; 14:2980–2984.
    1. Cheung CY, Chan HW, Liu YL, et al. Long–term graft function with tacrolimus and cyclosporine in renal transplantation: paired kidney analysis. Nephrology (Carlton) 2009; 14:758–763.
    1. Artz MA, Boots JM, Ligtenberg G, et al. Improved cardiovascular risk profile and renal function in renal transplant patients after randomized conversion from cyclosporine to tacrolimus. J Am Soc Nephrol 2003; 14:1880–1888.
    1. Nankivell BJ, Alexander SI. Rejection of the kidney allograft. N Engl J Med 2010; 363:1451–1462.
    1. Meier–Kriesche HU, Schold JD, Srinivas TR, et al. Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant 2004; 4:378–383.
    1. El Ters M, Grande JP, Keddis MT, et al. Kidney allograft survival after acute rejection, the value of follow-up biopsies. Am J Transplant 2013; 13:2334–2341.
    1. Lim WH, Chadban SJ, Clayton P, et al. Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients. Clin Transplant 2012; 26:E428–E437.
    1. Carbone M, Mutimer D, Neuberger J, et al. C virus and nonliver solid organ transplantation. Transplantation 2013; 95:779–786.
    1. Mahmoud IM, Elhabashi AF, Elsawy E, et al. The impact of hepatitis C virus viremia on renal graft and patient survival: a 9-year prospective study. Am J Kidney Dis 2004; 43:131–139.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe