title: Renal dysfunction as a risk factor for mortality and cardiovascular disease in renal transplantation: experience from the Assessment of Lescol in Renal Transplantation trial.
abstract: BACKGROUND
  Renal-transplant recipients have shortened life expectancy primarily because of premature cardiovascular disease. Traditional and nontraditional risk factors for cardiovascular disease are prevalent in renal patients. In renal-transplant recipients, immunosuppressive therapy can be nephrotoxic and aggravate cardiovascular disease risk factors. Renal dysfunction has been established as a risk factor for cardiovascular disease and mortality in different populations. We evaluated the effects of baseline renal-transplant function on mortality and cardiovascular and renal endpoints in 1,052 placebo-treated patients of the Assessment of Lescol in Renal Transplantation trial.
  
  
  METHODS
  All renal-transplant recipients were on cyclosporine-based immunosuppressive therapy. Follow-up was 5 to 6 years, and endpoints included cardiac death, noncardiovascular death, all-cause mortality, major adverse cardiac event (MACE), stroke, nonfatal myocardial infarction, and graft loss.
  
  
  RESULTS
  Baseline serum creatinine was strongly and independently associated with increased cardiac, noncardiovascular, and all-cause mortality, as well as MACE and graft loss. Serum creatinine was not a risk factor for stroke or nonfatal myocardial infarction.
  
  
  CONCLUSIONS
  Elevated baseline serum creatinine in renal-transplant recipients is a strong and independent risk factor for all-cause, noncardiovascular and cardiac mortality, MACE, and graft loss.
authors.affiliation: University Hospital, Uppsala, Sweden. bengt.fellstrom@medsci.uu.se
authors.forename: Bengt
authors.initials: B
authors.lastname: Fellström
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.forename: Inga
authors.initials: I
authors.lastname: Soveri
authors.forename: Edward
authors.initials: E
authors.lastname: Cole
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: Hans H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Bart
authors.initials: B
authors.lastname: Maes
authors.forename: Claudio
authors.initials: C
authors.lastname: Gimpelewicz
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects / Q000627:therapeutic use*; D000077340:Fluvastatin; D006331:Heart Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D010919:Placebos; D012307:Risk Factors
chemical_list: D000975:Antioxidants; D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D010919:Placebos; D000077340:Fluvastatin