Role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant recipients

Background: Traditional risk factors like elevated homocysteine levels may not completely explain the higher CVD seen in RTRs. Identification and optimisation of modifiable risk factors may help to reduce the occurrence of CVD in such population. To study the role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant patients. Another objective was to evaluate the other risk factors in the occurrence of CVD in such population.Methods: Thirty renal transplant recipients and thirty healthy controls were studied. Inclusion criteria were transplant duration >6 months and patients with chronic stable renal function over the last 3 months. Samples for fasting plasma homocysteine were collected and plasma homocysteine was then estimated. All the patients were followed up every month for 6 months and evaluated for occurrence of any cardiovascular event.Results: The mean hornocysteine levels were found to be 27.4±7.902 µmol/L in cases and 10.86±1.98 µmol/L in controls. There was no statistically significant relationship between homocysteine levels and transplant duration, mean IMT levels, proteinuria, and presence of left ventricular hypertrophy or choice of immunosuppressive regimen. Of the 30 patients, 6 patients (20%) had evidence of cardiovascular event. In the absence of other conventional factors, age of the patient, creatinine clearance (index of graft function) and mean intima-media thickness were more closely related with cardiovascular events. Conclusions: Plasma homocysteine failed to show as an independent risk factor for cardiovascular events. New, emerging cardiovascular risk factors (e.g. Lipoprotein (a), high sensitivity C-reactive protein, fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1) should be studied to design effective therapy to delay the progression of atherosclerosis and prolong the life of renal transplant recipients.

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Acute kidney injury in renal transplant recipients undergoing cardiac surgery

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa063 ◽

2020 ◽

Vol 36 (1) ◽

pp. 185-196

Author(s):

Gregory L Hundemer ◽

Anand Srivastava ◽

Kirolos A Jacob ◽

Neeraja Krishnasamudram ◽

Salman Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Risk Factor ◽

Renal Transplant ◽

Kidney Disease ◽

Kidney Injury ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Trough Levels

Abstract Background Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36–5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). Conclusions RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

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Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients

Transplantation Proceedings ◽

10.1016/j.transproceed.2015.08.038 ◽

2015 ◽

Vol 47 (8) ◽

pp. 2368-2370 ◽

Cited By ~ 4

Author(s):

P. Munguia ◽

R. Caramelo ◽

M.V. Rubio ◽

L. Sahdalá ◽

L. Arnaudas ◽

...

Keyword(s):

Risk Factor ◽

Renal Transplant ◽

Vascular Calcification ◽

Cardiovascular Events ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients

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RISK FACTORS FOR CHRONIC SUBCLINICAL INFLAMMATION (CSI) IN NON-DIABETIC RENAL TRANSPLANT RECIPIENTS (RTR): THE ROLE OF GLYCATED HEMOGLOBIN (HbA1c).

Transplantation Journal ◽

10.1097/00007890-200607152-02686 ◽

2006 ◽

Vol 82 (Suppl 2) ◽

pp. 952

Author(s):

&NA;

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Glycated Hemoglobin ◽

Renal Transplant Recipients ◽

Subclinical Inflammation ◽

Transplant Recipients

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Low levels of high-density lipoprotein cholesterol: an independent risk factor for late adverse cardiovascular events in renal transplant recipients

Transplant International ◽

10.1111/j.1432-2277.2009.01021.x ◽

2009 ◽

Vol 23 (6) ◽

pp. 574-579 ◽

Cited By ~ 8

Author(s):

Kulpreet Barn ◽

Mark Laftavi ◽

Drew Pierce ◽

Chin Ying ◽

William E. Boden ◽

...

Keyword(s):

Risk Factor ◽

Renal Transplant ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Cardiovascular Events ◽

Independent Risk Factor ◽

Density Lipoprotein ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Low Levels

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Post-Transplant Diabetes Mellitus and Prediabetes in Renal Transplant Recipients: An Update

Nephron ◽

10.1159/000514288 ◽

2021 ◽

pp. 1-13

Author(s):

Ana Elena Rodríguez-Rodríguez ◽

Esteban Porrini ◽

Mads Hornum ◽

Javier Donate-Correa ◽

Raúl Morales-Febles ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Transplant ◽

Cell Function ◽

Cell Damage ◽

Current Evidence ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Post Transplant ◽

Β Cell Function

Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.

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