Incidence of cardiovascular events and associated risk factors in kidney transplant patients: a competing risks survival analysis

María Teresa Seoane-Pillado, Salvador Pita-Fernández, Francisco Valdés-Cañedo, Rocio Seijo-Bestilleiro, Sonia Pértega-Díaz, Constantino Fernández-Rivera, Ángel Alonso-Hernández, Cristina González-Martín, Vanesa Balboa-Barreiro, María Teresa Seoane-Pillado, Salvador Pita-Fernández, Francisco Valdés-Cañedo, Rocio Seijo-Bestilleiro, Sonia Pértega-Díaz, Constantino Fernández-Rivera, Ángel Alonso-Hernández, Cristina González-Martín, Vanesa Balboa-Barreiro

Abstract

Background: The high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients.

Methods: An observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981-2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events. Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390-459, except: 427.5, 435, 446, 459.0).

Results: The mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes.

Conclusions: This study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events.

Keywords: Cardiovascular diseases; Kidney transplantation; Risk factors; Survival analysis.

Figures

Fig. 1
Fig. 1
Accumulated incidents according to event (cardiovascular event, loss of graft or death of the patient)

References

    1. Foley R, Parfrey P, Sarnak M. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9(Suppl 12):S16–23.
    1. Pilmore H, Dent H, Chang S, et al. Reduction in cardiovascular death after kidney transplantation. Transplantation. 2010;89:851–7. doi: 10.1097/TP.0b013e3181caeead.
    1. U.S. Renal Data System . USRDS 2014 annual data report: volume one: chronic kidney disease in the United States and volume two: end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2014.
    1. Hernández D, Sánchez-Fructuoso A, González-Posada J, et al. A novel risk score for mortality in renal transplant recipients beyond the first posttransplant year. Transplantation. 2009;88:803–9. doi: 10.1097/TP.0b013e3181b4ac2f.
    1. Lentine K, Rey L, Kolli S, et al. Variations in the risk for cerebrovascular events after kidney transplant compared with experience on the waiting list and after graft failure. Clin J Am Soc Nephrol. 2008;3:1090–101. doi: 10.2215/CJN.03080707.
    1. Jardine A, Gaston R, Fellstrom B, et al. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet. 2011;378:1419–27. doi: 10.1016/S0140-6736(11)61334-2.
    1. Svensson M, Jardine A, Fellström B, Holdaas H. Prevention of cardiovascular disease after renal transplantation. Curr Opin Organ Transplant. 2012;17(4):393–400.
    1. Special Issue KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9:S1–155.
    1. Pita-Fernández S, Pértega-Díaz S, Valdés-Cañedo F, Seijo-Bestilleiro R, Seoane-Pillado T, Fernández-Rivera C, Alonso-Hernández A, Lorenzo-Aguiar D, López-Calvino B, López-Muñiz A. Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol. BMC Cardiovasc Disord. 2011;11:2.
    1. Kalbfleisch J, Prentice R. The statistical analysis of failure time data. New York: Wiley; 1980.
    1. Gray R. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54. doi: 10.1214/aos/1176350951.
    1. Fine J, Gray R. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496. doi: 10.1080/01621459.1999.10474144.
    1. Israni A, Snyder J, Skeans M, et al. Predicting coronary heart disease after kidney transplantation: patient outcomes in renal transplantation (PORT) study. Am J Transplant. 2010;10:338–53. doi: 10.1111/j.1600-6143.2009.02949.x.
    1. Lentine K. Incidence and predictors of myocardial infarction after kidney transplantation. J Am Soc Nephrol. 2005;16:496–506. doi: 10.1681/ASN.2004070580.
    1. Kasiske B. Epidemiology of cardiovascular disease after renal transplantation. Transplantation. 2001;72(Supplement):S5–8. doi: 10.1097/00007890-200109271-00003.
    1. Jardine A, Fellström B, Logan J, et al. Cardiovascular risk and renal transplantation: post hoc analyses of the assessment of lescol in renal transplantation (ALERT) study. Am J Kidney Dis. 2005;46:529–36. doi: 10.1053/j.ajkd.2005.05.014.
    1. Weiner D, Carpenter M, Levey A, et al. Kidney function and risk of cardiovascular disease and mortality in kidney trasplant recipients: the FAVORIT trial. Am J Transplant. 2012;12:2437–45. doi: 10.1111/j.1600-6143.2012.04101.x.
    1. Kasiske B, Snyder J, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3:178–85. doi: 10.1034/j.1600-6143.2003.00010.x.
    1. Martínez-Castelao A, Hernández M, Pascual J, et al. Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study. Transplant Proc. 2005;37:3813–6. doi: 10.1016/j.transproceed.2005.10.035.
    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. Transplantation. 2003;75:SS3–24. doi: 10.1097/01.TP.0000069952.49242.3E.
    1. Porrini E, Moreno J, Osuna A, et al. Prediabetes in patients receiving tacrolimus in the first year after kidney transplantation: a prospective and multicenter study. Transplantation. 2008;85:1133–8. doi: 10.1097/TP.0b013e31816b16bd.
    1. Lee E, Go O. Survival analysis in public health research. Annu Rev Public Health. 1997;18:105–34. doi: 10.1146/annurev.publhealth.18.1.105.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir