Kidney function and risk of cardiovascular disease and mortality in kidney transplant recipients: the FAVORIT trial

Abstract

In kidney transplant recipients, cardiovascular disease (CVD) is the leading cause of death. The relationship of kidney function with CVD outcomes in transplant recipients remains uncertain. We performed a post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial to assess risk factors for CVD and mortality in kidney transplant recipients. Following adjustment for demographic, clinical and transplant characteristics, and traditional CVD risk factors, proportional hazards models were used to explore the association of estimated GFR with incident CVD and all-cause mortality. In 4016 participants, mean age was 52 years and 20% had prior CVD. Mean eGFR was 49 ± 18 mL/min/1.73 m(2) . In 3676 participants with complete data, there were 527 CVD events over a median of 3.8 years. Following adjustment, each 5 mL/min/1.73 m(2) higher eGFR at levels below 45 mL/min/1.73 m(2) was associated with a 15% lower risk of both CVD [HR = 0.85 (0.80, 0.90)] and death [HR = 0.85 (0.79, 0.90)], while there was no association between eGFR and outcomes at levels above 45 mL/min/1.73 m(2) . In conclusion, in stable kidney transplant recipients, lower eGFR is independently associated with adverse events, suggesting that reduced kidney function itself rather than preexisting comorbidity may lead to CVD.

Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation

© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1

Flowchart of FAVORIT cohort members. Censored analyses indicate individuals for whom event ascertainment ceased at 3 months post-dialysis initiation.

Figure 2

Adjusted survival estimates for (A) Primary CVD outcomes and (B) All-cause mortality outcomes stratified by baseline eGFR. Figures depict the product-limit estimates of the survivor function at mean levels for continuous covariates and for the reference group as displayed in Table 2 for categorical variables. Analyses exclude participants with missing covariate data.

Figure 2

Adjusted survival estimates for (A) Primary CVD outcomes and (B) All-cause mortality outcomes stratified by baseline eGFR. Figures depict the product-limit estimates of the survivor function at mean levels for continuous covariates and for the reference group as displayed in Table 2 for categorical variables. Analyses exclude participants with missing covariate data.

Figure 3

Hazard of CVD and mortality outcomes in extended models censoring 3-months after recurrent kidney failure.