Age-related and blood pressure-independent reduction in aortic stiffness after kidney transplantation.
OBJECTIVE
Aortic stiffness is a novel cardiovascular risk factor in patients with chronic kidney disease (CKD). The purpose of the present study is to examine whether there is a blood pressure-independent improvement in aortic stiffness 3 months after successful kidney transplantation (KTx), and whether this improvement is age-dependent.


METHODS
In this prospective, longitudinal observational study, we studied hemodynamic and biological parameters prior to and 3 months after a KTx in 52 stage 5 CKD patients. Aortic stiffness was measured by carotido-femoral pulse wave velocity (c-f PWV) and enhanced central wave reflection was evaluated by the heart rate-adjusted central augmentation index (AIx) by means of arterial tonometry. Endothelin-1, L-arginine, asymmetric dimethylarginine (biomarkers of endothelial dysfunction), pentosidine (advanced glycation end-products) and mineral metabolism parameters were also measured.


RESULTS
After adjusting for the reduction in mean blood pressure, c-f PWV decreased significantly from 12.1 ± 3.3 to 11.6 ± 2.3 m/s (P < 0.05). In an analysis stratified by age, this improvement was only present in patients older than 50 years of age as compared with patients younger than 50 years of age (-5.5 ± 2.2 vs. 2.1 ± 1.9%, P < 0.05). AIx decreased from 22 ± 11 to 14 ± 13% (P < 0.01), but this reduction was not age-dependent. We also observed a similar degree of improvement in the biomarker levels of endothelial dysfunction and pentosidine in both groups.


CONCLUSIONS
This study shows for the first time that there is an age-dependent improvement in aortic stiffness after KTx. These observations suggest that older patients may have an added cardiovascular risk reduction after a successful KTx.
Ignace
Sophie
S
Division of Nephrology and CHUQ Research Centre, L'Hôtel-Dieu de Québec Hospital and Department of Medicine, Université Laval, Quebec city, Quebec, Canada.
Utescu
Mihai S
MS
De Serres
Sacha A
SA
Marquis
Karine
K
Gaudreault-Tremblay
Marie-Michèle
MM
Larivière
Richard
R
Côté
Isabelle
I
Houde
Isabelle
I
Lebel
Marcel
M
Agharazii
Mohsen
M
D000328:Adult; D001011:Aorta / Q000503:physiopathology*; D001794:Blood Pressure; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies