Assessment of cardiovascular risk factors after renal transplantation: a step towards reducing graft failure.
BACKGROUND
Prolongation of renal allograft survival a considerable challenge. The primary cause of renal graft failure is recipient death and cardiovascular disease is the leading cause of mortality. We assessed the management of hypertension, dyslipidemia and diabetes mellitus (DM) in a protocol-driven renal transplant clinic.


METHODS
We reviewed 128 patients who received a renal allograft between 2004 and 2008 at our institution. Blood pressure (BP), low density lipoprotein (LDL) and hemoglobin AlC (HbAlC) were assessed annually for up to 5 years. Results were compared with the Kidney Disease: Improving Global Outcomes guidelines which target BP at ≤ 130/80 mmHg, LDL ≤ 100 mg/dL, and HbAlC ≤ 7.5%. Use of statins and antihypertensive medications was reviewed. Chi-square and t tests were used for analysis.


RESULTS
A history of hypertension, dyslipidemia, and DM were present in 96.1%, 60.9%, and 43.8%, respectively. The percentage of patients on ≥ 3 antihypertensive medications, statins, and other lipid-lowering medications were 38.01%, 44.5%, and 17.2%, respectively. One-year posttransplant targets for BP, LDL, and HbAlC were achieved in 41.4%, 71.7%, and 70.5% of patients, respectively. Five-year posttransplant target BP, LDL, and HbAlC were achieved in 55%, 91.7%, and 88.9% of patients, respectively.


CONCLUSIONS
Even in a university-based clinic with protocols designed to improve compliance, treatment goals for BP, LDL, and HbAlC were not achieved in a substantial number of patients, especially in the first year posttransplantation. Better strategies are needed to meet treatment objectives and prevent untoward outcomes.
Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA.
R
R
Kumar
J
J
Brar
R
R
Yacoub
T
T
Khan
M
M
Zachariah
R
R
Venuto
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006085:Graft Survival; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009518:New York; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007166:Immunosuppressive Agents; D008077:Lipoproteins, LDL; C517652:hemoglobin A1c protein, human