Assessment of Arterial Stiffness Over the First 12 Months Post Kidney Transplant.

Abstract

Purpose: The leading cause of death in end stage renal disease is cardiovascular disease (CVD) in part due to vascular arterial calcifications from abnormal mineral metabolism and inflammation related to poor kidney function. Kidney transplantation leads to improved survival, with restoration of kidney function improving mineral metabolism and inflammation. We hypothesized that arterial stiffness (as a surrogate for arterial calcification) would be improved in patients receiving a kidney transplant, potentially explaining one mechanism of survival benefit from transplant. Methods: We performed a longitudinal prospective cohort study of 66 newly transplanted adult kidney transplant recipients, using pulse wave velocity (PWV) to assess arterial stiffness over a 12 month period. All patients were assessed at time of transplant (baseline) and 12 months post transplant. The primary outcome was change in PWV score at 12 months. Secondary analyses included baseline predictors of PWV score at 12 months. Analyses were conducted using R version 3.0.2. Results: The median age of the cohort was 49.7 years at transplant, with 27% Black and 27% female. At baseline, 43% had tobacco use, 30% had a history of CVD, and 42% had diabetes. Median baseline calcium was 9.1 mg/dL and median phosphorus was 5.1 mg/dL. Median PWV score was 9.25 and 8.97 m/sec at baseline versus month 12, respectively, showing no significant change (median change of -0.07, p = 0.7). In multivariable regression, subjects with increased age at transplant (p=0.008), diabetes (p=0.002), and a higher baseline PWV score (p<0.001) were at increased risk of having a high PWV score 12 months post transplant. Conclusion: Arterial stiffness does not progress in the first year post kidney transplant. Increasing age, diabetes, and higher baseline PWV score identify patients at higher risk for increased arterial stiffness. Future research is needed regarding slowed arterial calcification after transplant. DISCLOSURES:Ikizler, T.: Grant/Research Support, Baxter Renal Care, Other, DSI, Inc., consultant, Satellite Health, consultant, AMGEN, consultant, Affymax, consultant, Abbot Nutrition and Abbot Renal, consultant.