Incidence of cardiovascular events in renal transplant recipients and clinical relevance of modifiable variables.
BACKGROUND
The aims of this study were to quantify the incidence of cardiovascular events and identify the clinical relevance of modifiable variables.


METHODS
The 1729 patients who underwent renal transplantation from 1981 to 2004 were evaluated in an observational, prospective follow-up study with no exclusions. A cardiovascular event was defined as the presence of ischemic cardiac disease (chest pain-myocardial infarction), cardiac insufficiency, arrhythmia (auricular fibrillation), peripheral vascular disease, or cerebrovascular accident. A survival analysis was performed using the Kaplan-Meier method. A Cox regression analysis was applied. Having identified the predictive variables of cardiovascular events, the population attributable fraction (PAF) and the etiological fraction (EF) were estimated. A risk score was calculated using Cox regression coefficients.


RESULTS
The accumulated incidence of cardiovascular events was 22.2%, with an incidence rate of 468.6 x 10,000 follow-up years. From the Cox regression model, the variables with an independent effect close to statistical significance to predict cardiovascular events were as follows: recipient age (RR = 1.05), smoking at the time of the transplantation (RR = 2.1), left ventricle hypertrophy during follow-up (RR = 2.4), prior diabetes mellitus, and obesity (body mass index >or=30). At the time of transplantation, 41.7% were smokers. During follow-up, a clear difference was observed in the incidence rates of cardiovascular events between smokers and nonsmokers. Similar phenomena were observed for left ventricle hypertrophy and obesity. The resulting scores ranged between 0 and 5. The area under the ROC curve of the score for the prediction of cardiovascular events was 0.74.


CONCLUSIONS
The incidence of cardiovascular events was consistent with the literature. A series of modifiable variables of major clinical relevance exist to decrease the frequency of cardiovascular events following renal transplantation.
Valdés-Cañedo
F
F
Department of Nephrology, Juan Canalejo Hospital, A Coruña, Spain. franvalc@terra.es
Pita-Fernández
S
S
Seijo-Bestilleiro
R
R
Pértega-Díaz
S
S
Alonso-Hernández
A
A
Cillero-Rego
S
S
Fernández-Rivera
C
C
Oliver-García
J
J
D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003404:Creatinine / Q000378:metabolism; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D017211:Treatment Failure
D003404:Creatinine