Long-term evaluation of coronary artery calcifications in kidney transplanted patients: a follow up of 5 years

C Alfieri,A Regalia,P Messa,F Tripodi,D Cresseri,L Forzenigo,M Meneghini

doi:10.1038/s41598-019-43216-4

Abstract

Coronary artery calcifications(CACs), are related to the increased cardiovascular mortality during kidney transplantation(KTx). Using coronary-CT performed at 1 month(T0) and 5 years(T5) after KTx we evaluated: (1) the prevalence of CACs; (2) the clinical and biochemical factors related to CACs; 3) the factors implicated with CACs progression. We evaluated 67-pts selected from the 103-pts transplanted in our unit between 2007 and 2008. Clinical and biochemical parameters were recorded at the time of pre-KTx evaluation and for five years after KTx. Coronary-CT for the Agatson score (AS) evaluation was performed at T0 and at T5, and CACs progression was determined. At baseline AS was 45 [0–233]. At T5 AS was 119 [1–413]. At T0, 69% of patients had CACs. Age and dialytic vintage were the main independent variables related to CACs. At T5, CACs were present in 76% of patients. Age was the only independent factor in determining CACs. A progression of CACs was observed in 74% of patients. They were older, had higher CACs-T0 and higher SBP throughout the 5-years. The presence of CACs at T0 and age were the only independent factors in determining the CACs-progression. CACs-T0 had the best discriminative power for CACs progression. CACs prevalence is quite high in KTx patients; Age is strictly related to CACs; Age and the presence of CACs at baseline were the two major factors associated with the progression of CACs during the five years of follow up. CACs-T0 had the best discriminative power for progression of CACs.

Highlights

Patients affected by chronic kidney disease (CKD) have a relevant cardiovascular risk1,2
The aim of the present study is to explore, by means of Multislice Coronary CT (CT), the prevalence of CACs and the rate of their modification in a cohort of 67 patents evaluated for CACs at one month and at five years after KTx
Forty-five patients received hemodialysis before KTx and 59 patients were transplanted from a deceased donor

Summary

Introduction

Patients affected by chronic kidney disease (CKD) have a relevant cardiovascular risk1,2 In those patients, the prevalence and incidence of cardiovascular (CV) events are much higher than in the general population, and CV events are the most common cause of death. In consideration of the potential high impact of CACs and of their relation with CV events and mortality, several clinical studies focused on the factors implicated on CACs progression have been realized5,6 In those studies, including mainly CKD and end stage renal disease (ESRD) patients, a higher rate of increase of CACs than in the general population and a relation among CACs progression, age and mineral metabolism factors have been reported. A small amount of data on the long term behavior of CACs in kidney transplantation (KTx) are available, and the few studies available are characterized by a small quantity of patients and a short observational time

Objectives

Methods

Results

Conclusion