title: A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal transplantation.
abstract: OBJECTIVE
  The role of reversibility of nontraditional risk factors, like inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined.
  
  
  METHODS
  The longitudinal relationship between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32±10 years) with stage 5 CKD maintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation.
  
  
  RESULTS
  Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis (average=0.9±0.2 mm) was higher (P<0.001) than in well matched healthy controls (0.6±0.1 mm) and reduced substantially (-22%; 95% confidence interval, -24% to -20%) after transplantation (P=0.001). GFR (multivariable-adjusted β=0.23; P<0.001), C-reactive protein (β=0.15; P<0.001), and fibroblast growth factor 23 (β=0.28; P<0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent correlates of simultaneous changes in intima media thickness (C-reactive protein: β=0.25; fibroblast growth factor 23: β=0.26; P<0.001 for both) after renal transplantation. The evolution of intima media thickness after transplantation was largely independent of classic risk factors, including BP, LDL cholesterol, and insulin resistance, as measured by homeostatic model assessment.
  
  
  CONCLUSIONS
  Intima media thickness improves after renal transplantation. Such an improvement associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation, in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and CKD-mineral bone disorder.
authors.affiliation: Departments of Nephrology, mahmutiyilmaz@yahoo.com.
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.affiliation: Endocrinology.
authors.forename: Alper
authors.initials: A
authors.lastname: Sonmez
authors.affiliation: Radiology.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.affiliation: Biochemistry, and.
authors.forename: Tuncer
authors.initials: T
authors.lastname: Cayci
authors.affiliation: Epidemiology, Gulhane School of Medicine, Etlik-Ankara, Turkey; and.
authors.forename: Selim
authors.initials: S
authors.lastname: Kilic
authors.affiliation: Departments of Nephrology.
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.affiliation: Departments of Nephrology.
authors.forename: Murat
authors.initials: M
authors.lastname: Karaman
authors.affiliation: Departments of Nephrology.
authors.forename: Hakki
authors.initials: H
authors.lastname: Cetinkaya
authors.affiliation: Departments of Nephrology.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Eyileten
authors.affiliation: Departments of Nephrology.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gok
authors.affiliation: Departments of Nephrology.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.affiliation: Departments of Nephrology.
authors.forename: Abdulgaffar
authors.initials: A
authors.lastname: Vural
authors.affiliation: Nephrology, Hypertension and Renal Transplantation and National Research Council-Institute of Clinical Physiology Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.affiliation: National Research Council-Institute of Clinical Physiology Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D002340:Carotid Artery Diseases / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011184:Postoperative Period; D057234:Preoperative Period; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002097:C-Reactive Protein; D002118:Calcium
keywords: arteriosclerosis; chronic inflammation; renal transplantation