Arterial Stiffness Is Associated With Increased Mortality in Renal Transplant Recipients.

Abstract

Introduction: Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients (RTRs). Arterial stiffness is a risk factor for the development of CVD. Objectives: The aim of the present study was to assess the effect of arterial stiffness on mortality after renal transplantation. Methods: Study participants were 772 adult RTRs, transplanted between 2006 and 2011, with a median follow-up of 2.8 years. Using a multivariate Cox proportional hazard model, associations between arterial distensibility, measured by SphygmoCor® pulse wave velocity (PWV) 10 weeks after transplantation, and mortality endpoints were determined. The following predefined variables were included in the model: Age, gender, number of antihypertensive drugs, smoking status, estimated glomerular filtration rate, total cholesterol, uric acid, phosphate, total calcium, body mass index, preemptive transplantation and pretransplant dialysis treatment duration, diabetes, peripheral vascular-, cardiac- and cerebrovascular disease. Results: Forty patients died (5.2 %) during follow-up. There was a 13% all-cause mortality risk increase per 1.0 m/sec increase in PWV (adjusted hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.02 - 1.26, p=0.02). When divided into tertiles according to PWV values, patients in the upper tertile compared with the lower had an increased all-cause mortality risk (adjusted HR 5.74, 95% CI 1.13 - 29.00, p=0.04). In 10 out of 17 deaths caused by CVD, the patient belonged to the upper PWV tertile. However, association between PWV and cardiovascular mortality was not statistically significant (adjusted HR 4.97, p=0.17), possibly due to a low event rate. Conclusion: Increasing PWV, hence increasing arterial stiffness, was associated with reduced survival in RTRs.Figure 1.: Kaplan Meier plot. Proportion of surviving patients by tertiles of pulse wave velocity values.