title: Assessment of arterial stiffness using pulse wave velocity in tacrolimus users the first year post kidney transplantation: a prospective cohort study.
abstract: BACKGROUND
  The leading cause of death in end stage renal disease is cardiovascular disease (CVD). Kidney transplantation is associated with improved survival over dialysis. We hypothesized that arterial stiffness, a marker of CVD, would improve in patients post kidney transplant, potentially explaining one mechanism of survival benefit from transplant.
  
  
  METHODS
  After obtaining Institutional Review Board approval and informed consent, we performed a longitudinal prospective cohort study of 66 newly transplanted adult kidney transplant recipients, using aortic pulse wave velocity (PWV) to assess arterial stiffness over a 12 month period. All patients were assessed within one month of transplant (baseline) and 12 months post transplant. The primary outcome was change in PWV score at 12 months which we assessed using Wilcoxon Signed Rank test. Secondary analyses included correlation of predictors with PWV score at both time points.
  
  
  RESULTS
  The median age of the cohort was 49.7 years at transplant, with 27 % Black and 27 % female. At baseline, 43 % had tobacco use, 30 % had a history of CVD, and 42 % had diabetes. Median baseline calcium was 9.1 mg/dL and median phosphorus was 5.1 mg/dL. Median PWV score was 9.25 and 8.97 m/s at baseline versus month 12, respectively, showing no significant change (median change of -0.07, p = 0.7). In multivariable regression, subjects with increased age at transplant (p = 0.008), diabetes (p = 0.002), and a higher baseline PWV score (p < 0.001) were at increased risk of having a high PWV score 12 months post transplant.
  
  
  CONCLUSIONS
  Aortic arterial stiffness does not progress in the first year post kidney transplant. Increasing age, diabetes, and higher baseline PWV score identify patients at risk for increased arterial stiffness. Further research that assesses patients for greater than one year and includes a control dialysis group would be helpful in further understanding the change in arterial stiffness post transplantation.
authors.affiliation: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA. kelly.birdwell@vanderbilt.edu.
authors.forename: Kelly Ann
authors.initials: KA
authors.lastname: Birdwell
authors.affiliation: University at Buffalo School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY, 14260, USA. giladjaf@buffalo.edu.
authors.forename: Gilad
authors.initials: G
authors.lastname: Jaffe
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA. anna.bian@Vanderbilt.edu.
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA. pingsheng.wu@Vanderbilt.edu.
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA. alp.ikizler@Vanderbilt.edu.
authors.forename: Talat Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D000328:Adult; D000367:Age Factors; D001011:Aorta / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D016559:Tacrolimus / Q000627:therapeutic use; D059289:Vascular Stiffness
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus