scholarly journals Physical activity and risk of cardiovascular events and all-cause mortality among kidney transplant recipients

2020 ◽  
Vol 35 (8) ◽  
pp. 1436-1443
Author(s):  
Augustine W Kang ◽  
Andrew G Bostom ◽  
Hongseok Kim ◽  
Charles B Eaton ◽  
Reginald Gohh ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Proportional Hazards ◽  
Controlled Trial ◽  
Cox Proportional Hazards ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Background Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. Methods A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan–Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. Results Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59–0.98]}, CVD mortality [HR 0.58 (95% CI 0.35–0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59–0.98)]. Results were similar in unadjusted models. Conclusions PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.

scholarly journals Pretransplant Physical Activity Predicts All-Cause Mortality in Kidney Transplant Recipients

2011 ◽  
Vol 35 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Sylvia E. Rosas ◽  
Peter P. Reese ◽  
Yonghong Huan ◽  
Cataldo Doria ◽  
Philip T. Cochetti ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
All Cause Mortality

Abstract MP35: Physical Activity and Risk of Cardiovascular Events and All-Cause Mortality Among Kidney Transplant Recipients

Circulation ◽  
2019 ◽  
Vol 139 (Suppl_1) ◽  
Author(s):  
Augustine Kang ◽  
Hongseok Kim ◽  
Carol E Garber ◽  
Charles Eaton ◽  
Patricia M Risica ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Cardiovascular Events ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
All Cause Mortality

scholarly journals Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients

2019 ◽  
Vol 8 (12) ◽  
pp. 2064 ◽  
Author(s):  
Tomás A. Gacitúa ◽  
Camilo G. Sotomayor ◽  
Dion Groothof ◽  
Michele F. Eisenga ◽  
Robert A. Pol ◽  
...  
Keyword(s):  
Vitamin C ◽  
Kidney Transplant ◽  
Cardiovascular Mortality ◽  
Cancer Mortality ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Plasma Vitamin ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 ± 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 ± 20 μmol/L. At a median follow-up of 7.0 (IQR, 6.2–7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34–0.74; p < 0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83–1.62; p = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR.

scholarly journals INCREASING PHYSICAL ACTIVITY POST-KIDNEY TRANSPLANT: A PILOT RANDOMIZED CONTROLLED TRIAL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S521-S521
Author(s):  
Tara O’Brien ◽  
Cynthia Russell ◽  
Donna Hathaway
Keyword(s):  
Physical Activity ◽  
Kidney Transplant ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Randomized Controlled ◽  
Activity Trackers ◽  
Pilot Randomized Controlled Trial

Abstract Older kidney transplant recipients are at risk for graft failure and death due to lack of physical activity. Physical activity after transplant is the most modifiable non-pharmacological factor for improving physical function. One personal system intervention called, SystemCHANGE™ in combination with activity trackers, holds promise for increasing physical activity among this population. The purpose of this pilot randomized controlled trial was to evaluate the efficacy of SystemCHANGE™ on increasing average daily steps in older (age 60 and over) kidney transplant recipients from baseline to 6 months. The intervention group met monthly to implement a successful personal system solution based on their daily routines and step-data collected from the activity tracker. The control group received monthly educational information on healthy living with a transplant. Participants were randomized 1:1 to the intervention or control group. The sample consisted of 31 participants (n = 15 intervention, and n = 16 control). No significant differences were found at baseline among the groups for demographics, self-efficacy and health outcomes (blood pressure, weight, waist circumference, 6 minute Walk Test). However, the intervention group had greater increase in the average daily steps from baseline to 6 months (mean ± SD: 1511 ± 2320) as compared to the control group (181 ± 2419). The between-group difference was of medium effect size (d = .56).The data suggests SystemCHANGE™ in combination with activity trackers may be feasible for older kidney transplant recipients to enhance daily steps.

scholarly journals The Association of Plasma Trimethylamine N-Oxide With All-Cause and Cardiovascular Mortality: The Multi-Ethnic Study of Atherosclerosis

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 63-63
Author(s):  
Meng Wang ◽  
Xinmin Li ◽  
Zeneng Wang ◽  
Marcia de Oliveira Otto ◽  
Rozenn Lemaitre ◽  
...  
Keyword(s):  
Renal Function ◽  
Proportional Hazards ◽  
Healthy Eating Index ◽  
Cox Proportional Hazards ◽  
Ethnic Community ◽  
Cvd Risk ◽  
Community Based ◽  
Ethnic Study ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Objectives Trimethylamine N-oxide (TMAO) is a gut-microbiota generated metabolite of dietary phosphatidylcholine, choline, and carnitine. TMAO has been suggested to play a role in the pathogenesis of multiple diseases. Yet, studies of TMAO and mortality were conducted in convenience samples of patients with prevalent diseases and lacked socioeconomic and lifestyle data, raising the likelihood of selection bias and residual confounding. To address these research gaps, we investigated the associations of plasma TMAO levels with all-cause and cardiovascular disease (CVD) mortality in a prospective multi-ethnic community-based cohort. Methods The study included 6776 participants from the Multi-Ethnic Study of Atherosclerosis. TMAO was measured at baseline using mass spectrometry. Adjudicated CVD deaths included death due to coronary heart disease, stroke, other atherosclerotic diseases, or other CVDs. Multivariable Cox proportional hazards models assessed associations with adjustment for baseline sociodemographic, lifestyle, diet, and traditional CVD risk factors (BMI, blood pressure, lipids, diabetes, CRP, medications). We also assessed pre-specified interactions by age, sex, race/ethnicity, low vs. high adherence to Alternate Healthy Eating index, and renal function measured by creatinine-based estimated glomerular filtration rate (eGFR). Results During median follow-up of 15.9 years, 1548 participants died, 362 from CVD. Higher TMAO levels were associated with higher risk of both all-cause mortality (HR = 1.09, 95%CI: 1.04 - 1.13, per inter-quintile range increase, 7.5 µM/L) and CVD mortality (HR = 1.10, 95%CI: 1.02 - 1.19). Interaction by renal function was observed for all-cause mortality (P-interaction &lt; 0.005), with a positive association between TMAO and risk in those with impaired renal function (eGFR &lt; 60) [HR = 1.15, 95%CI: 1.09 -1.21], but not normal or mildly reduced renal function (eGFR ≥ 60) [HR = 1.02, 95%CI: 0.95 - 1.08]. No other significant interactions were observed. Conclusions In this multi-ethnic community-based cohort of US adults, higher plasma TMAO levels were associated with a higher risk of all-cause and CVD mortality. The mechanisms of interaction by renal function need to be further studied, especially given that TMAO is renally cleared. Funding Sources NIH

scholarly journals Renin-Angiotensin System Blockers and the Risk of COVID-19-Related Mortality in Patients with Kidney Failure

2021 ◽  
pp. CJN.18961220
Author(s):  
Maria Jose Soler ◽  
Marlies Noordzij ◽  
Daniel Abramowicz ◽  
Gabriel de Arriba ◽  
Carlo Basile ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Mortality Risk ◽  
Kidney Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Transplant Recipients ◽  
Angiotensin Ii Receptor ◽  
Kidney Transplant Recipients ◽  
Dialysis Patients ◽  
Converting Enzyme Inhibitors

Background: There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in patients with COVID-19. Patients with kidney failure, who often use ACEi/ARB, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Methods: Data were retrieved from the ERACODA database of kidney transplant and dialysis patients affected by COVID-19, between February 1 and October 1 2020, and had information on 28-day mortality. Cox proportional-hazards regression was used to calculate hazard ratios (HRs) for the relation between ACEi/ARB use and 28-day mortality risk. Additionally, we studied the association of ACEi/ARB discontinuation with 28-day mortality. Results: We evaluated 1,511 patients, 459 kidney transplant recipients and 1,052 dialysis patients. At COVID-19 diagnosis, 189 (41%) of the transplant and 288 (27%) of the dialysis patients were on ACEi/ARB. In transplant, 88 (19%) and in dialysis patients 244 (23%) died within 28 days of initial presentation. In transplant and dialysis patients, there was no association between ACEi/ARB use and 28-day mortality in both crude and adjusted models (adjusted HR=1.12, 95%CI: 0.69-1.83 in transplant; 1.04, 95%CI: 0.73-1.47 in dialysis patients). Among transplant recipients, ACEi/ARB discontinuation was associated with higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for COVID-19 severity (adjusted HR=1.36, 95%CI: 0.40-4.58). Among dialysis patients, ACEi/ARB discontinuation was not associated with mortality in any model. Similar results were obtained across subgroups when ACEi and ARB were studied separately and when other outcomes for COVID-19 severity were studied e.g., hospital admission, intensive care unit admission or need for ventilator support. Conclusions: Amongst kidney transplant and dialysis patients with COVID-19, there was no significant association of ACEi/ARB use or ACEi/ARB discontinuation with mortality.

CONTROLLED TRIAL OF IL2R ANTIBODY BASILIXIMAB (SIMULECT) VS LOW DOSE OKT3 IN CADAVER KIDNEY TRANSPLANT RECIPIENTS.

2000 ◽  
Vol 69 (Supplement) ◽  
pp. S156 ◽  
Author(s):  
Hamid Shidban ◽  
M. Sabawi ◽  
S. Aswad ◽  
G. Chambers ◽  
I. Castillon ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Low Dose ◽  
Controlled Trial ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cadaver Kidney

scholarly journals Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aziza Ajlan ◽  
Hassan Aleid ◽  
Tariq Zulfiquar Ali ◽  
Hala Joharji ◽  
Khalid Almeshari ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Double Blind ◽  
Donor Specific Antibodies

Abstract Background Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. Aims To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. Methods Prospective, randomized, double blind, non-inferiority, controlled clinical trial Expected outcomes 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. Secondary outcomes: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) Trial registration The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.

Abstract 16810: Myocardial Perfusion Abnormalities, Ejection Fraction, and Coronary Calcium Score Are Not Associated With All-Cause Mortality Among Potential Kidney Transplant Recipients at Emory University Hospital

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ryan S Cousins ◽  
Billy Mullinax ◽  
Lehman Godwin ◽  
Adam J Mitchell
Keyword(s):  
Multivariate Analysis ◽  
Coronary Artery ◽  
Kidney Transplant ◽  
Stress Testing ◽  
University Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Evaluation ◽  
Emory University ◽  
All Cause Mortality

Introduction: Screening for coronary artery disease in patients being considered for kidney transplant is common to stratify morbidity and mortality risk, but the optimal strategy, and its impact on outcomes, remains unclear. Here we test the hypothesis that myocardial perfusion imaging (MPI) abnormalities, left ventricular ejection fraction (LVEF), or coronary artery calcium (CAC) score are associated with all-cause mortality in potential kidney transplant recipients at Emory University Hospital (EUH). Methods: In a retrospective chart review, we assessed the relationship between patient demographics, single-photon emission MPI results, and CAC scoring with post-evaluation outcomes at 5 years in consecutive patients referred for pre-transplant stress testing at EUH in 2015. Mann-Whitney U and Chi-Square tests assessed between-group differences in continuous and categorical variables, respectively. Multivariate analysis was performed using logistic regression models. Results: During the study period, 589 patients (mean age 54 years; SEM 0.512, 58% male, 65% African American) underwent MPI and 424 also underwent CAC scoring. Overall, 90 patients (15%) had abnormal MPI (defined as any fixed or reversible defect) and 54 (9%) died during follow up. Age (mean 53.2 years; SEM 0.533 vs. 57.7 years; SEM 1.73, p=0.008), previous coronary artery bypass graft (CABG) (2.06% vs. 7.41%, p=0.017), and myocardial infarction (MI) post-evaluation (4.11% vs. 18.5%, p<0.001) were associated with all-cause mortality. Age (p=0.032) and MI post-evaluation (p<0.001) remained significant in multivariate analysis. MPI abnormalities, LVEF, and CAC score were not associated with all-cause mortality. Conclusions: Age and MI post-evaluation are associated with increased mortality in potential kidney transplant recipients referred for stress testing at EUH. We found no association between MPI abnormalities, LVEF, or CAC score and all-cause mortality.

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