Predictors of weight gain and cardiovascular risk in a cohort of racially diverse kidney transplant recipients

Abstract

OBJECTIVE: Renal transplantation is associated with an increased risk of atherosclerotic cardiovascular disease and marked racial and ethnic disparities in graft and patient survival. We characterized differences in racial and ethnic susceptibility to weight gain, diabetes, and alterations in circulating lipid levels and isolated independent predictors of those changes in a diverse population of kidney transplant recipients.METHODS: The data for this analysis were drawn from a prospectively collected database of 506 renal transplant recipients obtained between 1983 and 1998. Univariate and multivariate analyses characterized differences in outcomes and predictors of cardiovascular risk by race and ethnicity.RESULTS: In all recipients, coronary artery disease was the most common cause of death, and African-American recipients had the shortest graft survival and the highest percentage of deaths. At 1 y post-transplantation, 39% of African-American recipients were obese (body mass index > 30), and the odds ratios for post-transplant diabetes were 3.5 and 5 times greater in non-white and obese recipients, respectively.CONCLUSIONS: Multiple regression analysis confirmed the predominant independent effect of African American race or ethnicity on weight gain; however, hypercholesterolemia was independent of race or ethnicity and predicted by cyclosporine treatment and post-transplant diabetes. Therefore, kidney transplantation represents a state of accelerated atherogenic risk induced in part by the metabolic effects of immunosuppressive medications and compounded by marked racial and ethnic disparities in weight gain and diabetes risk.