title: Long term evolution of endothelial function during kidney transplantation.
abstract: Endothelial dysfunction is an important precursor to the development of atherosclerosis, and has been suggested to play a role in the increased cardiovascular risk in patients with end stage renal disease. Endothelial function improves rapidly following post kidney transplantation, but the long term change remains unclear. Hypothesizing that endothelial function would remain improved long term post kidney transplantation, we evaluated the longitudinal change of endothelial function, measured by flow-mediated dilation (FMD) of the brachial artery, from months 1 to 24 post transplantation. Given the previously reported association of fibroblast growth factor 23 (FGF-23) with endothelial dysfunction, we also examined changes in the association between FGF-23 levels and the change in FMD following kidney transplantation.
  
  
  
  We performed a prospective cohort study of 149 kidney transplant recipients, measuring endothelial function by FMD at months 1, 12, and 24 post-transplant. FGF-23 levels were measured at months 1 and 24 post-transplant. Linear mixed effects models were used to assess both the unadjusted and adjusted outcomes.
  
  
  
  The cohort (mean age 49 ± 13 years) was 74 % male and 75 % white. The median FMD was 6.3 % (IQR: 3.4, 10.2), 5.4 % (IQR: 3.1, 8.5), and 5.6 % (IQR: 3.5, 9.1) at 1, 12, and 24 months, respectively. After adjustment for covariates, compared to month 1, no change occurred in FMD at 12 months (-0.66 %; 95 % CI: -1.81 %, 0.49 %; P = 0.262) or 24 months (-0.25 %; 95%CI: -1.76 %, 1.26 %; P = 0.746). FGF-23 decreased significantly over time (P = 0.024), but there was no significant association between FGF-23 and FMD (P = 0.799).
  
  
  
  Endothelial function remained stable at 12 and 24 months from 1 month post-kidney transplant, indicating that the improved endothelial function seen with transplant is maintained up to 2 years post transplantation. There was also no significant association between FGF-23 and endothelial function following kidney transplantation.
authors: Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, D4313 MCN, Nashville, TN, 37232, USA.
authors: Clark
authors: C
authors: Kensinger
authors: Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA.
authors: Aihua
authors: A
authors: Bian
authors: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA.
authors: Meagan
authors: M
authors: Fairchild
authors: Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA.
authors: Guanhua
authors: G
authors: Chen
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 600, Nashville, TN, 37203, USA.
authors: Loren
authors: L
authors: Lipworth
authors: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA.
authors: T Alp
authors: TA
authors: Ikizler
authors: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA. Kelly.Birdwell@vanderbilt.edu.|Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 34232, USA. Kelly.Birdwell@vanderbilt.edu.
authors: Kelly A
authors: KA
authors: Birdwell
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology*; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Cardiovascular disease; Cardiovascular risk factors; Endothelial dysfunction; Flow-mediated dilation; Kidney transplantation