Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation.

Jin Ho Hwang,Dong Wan Chae,Jung Pyo Lee,Yon Su Kim,Duck-Jong Han,Hyosang Kim,Young Hoon Kim,Curie Ahn,Chun Soo Lim,Clara Tammy Kim,Jiwon Ryu,Su-Kil Park,Yun Kyu Oh,In Mok Jung,Jaeseok Yang,Jongwon Ha,Jung Nam An

doi:10.1186/s12882-015-0108-3

Abstract

BackgroundMalnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.MethodsWe enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2–4, 6, 8–10).ResultsThe patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84–20.32 p = 0.003).ConclusionsThe presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

Highlights

Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease
Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate and
Among the patients in whom kidney transplantation had been performed at Seoul National University Hospital, Seoul National University Boramae Medical Center, Seoul National University Bundang Hospital, and Asan Medical Center from Jun. 1999 through Dec. 2011, we reviewed the medical records of 2425 individuals and collected data from 1348 patients

Summary

Introduction

Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. The clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown. Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD) despite major research efforts and improvements in dialysis technology [1]. Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate and. With the development and advancement of immunosuppressive agents, renal allograft survival rates have improved over the years. The immunosuppressive agents increase atherosclerotic risk by elevating blood pressure and by aggravating several metabolic profiles such as dyslipidemia and new onset diabetes after transplantation (NODAT) [13, 14]

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