title: Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients.
abstract: Calcification of the vasculature is associated with cardiovascular disease and death in kidney transplant recipients. A novel functional blood test measures calcification propensity by quantifying the transformation time (T50 ) from primary to secondary calciprotein particles. Accelerated T50 indicates a diminished ability of serum to resist calcification. We measured T50 in 1435 patients 10 weeks after kidney transplantation during 2000-2003 (first era) and 2009-2012 (second era). Aortic pulse wave velocity (APWV) was measured at week 10 and after 1 year in 589 patients from the second era. Accelerated T50 was associated with diabetes, deceased donor, first transplant, rejection, stronger immunosuppression, first era, higher serum phosphate and lower albumin. T50 was not associated with progression of APWV. During a median follow-up of 5.1 years, 283 patients died, 70 from myocardial infarction, cardiac failure or sudden death. In Cox regression models, accelerated T50 was strongly and independently associated with both all-cause and cardiac mortality, low versus high T50 quartile: hazard ratio 1.60 (95% confidence interval [CI] 1.00-2.57), ptrend   = 0.03, and 3.60 (95% CI 1.10-11.83), ptrend   = 0.02, respectively. In conclusion, calcification propensity (T50 ) was strongly associated with all-cause and cardiac mortality of kidney transplant recipients, potentially via a cardiac nonAPWV-related pathway. Whether therapeutic improvement of T50 improves outcome awaits clarification in a randomized trial.
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
authors.forename: D O
authors.initials: DO
authors.lastname: Dahle
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.|Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway.|Norwegian Renal Registry, Oslo, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Åsberg
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Holdaas
authors.affiliation: Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Bachtler
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.|Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: T G
authors.initials: TG
authors.lastname: Jenssen
authors.affiliation: Calcisco AG, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Dionisi
authors.affiliation: Department of Clinical Research, University of Bern, Bern, Switzerland.|Department of Clinical Chemistry, University Hospital Bern, Inselspital, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Pasch
mesh_terms: D000328:Adult; D000368:Aged; D002113:Calcification, Physiologic; D002114:Calcinosis / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000097:blood / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D063177:Pulse Wave Analysis; D012307:Risk Factors; D066027:Transplant Recipients
keywords: cardiovascular disease; clinical research / practice; complication: medical / metabolic; epidemiology; kidney (allograft) function / dysfunction; kidney transplantation / nephrology; pancreas / simultaneous pancreaskidney transplantation