RENAL TRANSPLANT FUNCTION AS A RISK FACTOR FOR CARDIOVASCULAR DISEASE AND MORTALITY AND FOR ALL CAUSE MORTALITY IN RENAL TRANSPLANTATION - EXPERIENCE FROM THE ALERT TRIAL

Abstract

O148* Aims: ALERT is a randomised, placebo controlled study on effects of fluvastatin on cardiovascular and renal endpoints in 2100 transplant recipients with a stable function, included on an average 4 years post transplantation. Design and major outcomes have been published (Lancet, June 14, 2003). The importance of serum creatinine and renal function at baseline for reaching cardiac endpoints and all cause mortality have not been reported. Methods: Patients received Fluvastatin or Placebo, with a follow-up of 5 6 years. 66 % of patients were men, average age was 50 years. 85% of patients were first transplant recipients and 22 % were live donor recipients. Renal endpoints, cardiac disease and all cause mortality were pre-defined secondary endpoints. Serum creatinine was measured twice yearly. Results: The average serum creatinine at inclusion in the study was 147 umol/l (range 70- 300). The incidence of cardiac death, myocardial infarction, stroke and all cause mortality were captured during the course of the study, and related to renal transplant function at baseline. The RR for MACE was 1.63 per 100 umol/l increase in serum creatinine at baseline (P<0.0007). Similarly, the RR for cardiac death was 2.29 (p<0.00005), non-CV death 1.95 (p<0.0005) and all cause mortality 2.12 (p<0.00005) per 100 umol/l increase in serum creatinine. However, renal function was not a risk factor for non-fatal myocardial infarction (RR=1.12, p=0.646) or stroke (RR= 1.30, p=0.355) in this patient population. Conclusion: In renal transplant recipients with a stable function, serum creatinine is a powerful risk factor for cardiac death, non-CV death, all cause mortality but not for stroke or non-fatal myocardial infarction alone.