Assessment of arterial stiffness using pulse wave velocity in tacrolimus users the first year post kidney transplantation: a prospective cohort study.

Gilad Jaffe,Pingsheng Wu,Aihua Bian,Kelly Ann Birdwell,Talat Alp Ikizler

doi:10.1186/s12882-015-0092-7

Abstract

BackgroundThe leading cause of death in end stage renal disease is cardiovascular disease (CVD). Kidney transplantation is associated with improved survival over dialysis. We hypothesized that arterial stiffness, a marker of CVD, would improve in patients post kidney transplant, potentially explaining one mechanism of survival benefit from transplant.MethodsAfter obtaining Institutional Review Board approval and informed consent, we performed a longitudinal prospective cohort study of 66 newly transplanted adult kidney transplant recipients, using aortic pulse wave velocity (PWV) to assess arterial stiffness over a 12 month period. All patients were assessed within one month of transplant (baseline) and 12 months post transplant. The primary outcome was change in PWV score at 12 months which we assessed using Wilcoxon Signed Rank test. Secondary analyses included correlation of predictors with PWV score at both time points.ResultsThe 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/s 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.ConclusionAortic arterial stiffness does not progress in the first year post kidney transplant. Increasing age, diabetes, and higher baseline PWV score identify patients at risk for increased arterial stiffness. Further research that assesses patients for greater than one year and includes a control dialysis group would be helpful in further understanding the change in arterial stiffness post transplantation.

Highlights

The leading cause of death in end stage renal disease is cardiovascular disease (CVD)
Though often used in the research setting, several studies support using pulse wave velocity (PWV) in the clinic based on its reported associations with cardiovascular risk and all-cause mortality in a variety of patient populations, with one metaanalysis showing each increase of 1 m/s in aortic PWV being associated with a 15 % risk-adjusted increase in both cardiovascular and all-cause mortality [10]
Higher aortic PWV has been associated with all-cause mortality and cardiovascular events in few studies of prevalent kidney transplant recipients, but less is known about changes that may occur in arterial stiffness over time after successful kidney transplantation [15, 16]

Summary

Introduction

The leading cause of death in end stage renal disease is cardiovascular disease (CVD). Kidney transplantation leads to improved survival compared to wait-listed dialysis patients, making it the renal replacement therapy of choice in eligible patients [4]. The reasons for this survival advantage are likely multifactorial, but include improved cardiovascular risk as a result of return of kidney function [5,6,7]. Higher aortic PWV has been associated with all-cause mortality and cardiovascular events in few studies of prevalent kidney transplant recipients, but less is known about changes that may occur in arterial stiffness over time after successful kidney transplantation [15, 16]

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