scholarly journals Racial Difference in the Association of Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients

2021 ◽  
Vol 18 (8) ◽  
pp. 4297
Author(s):  
Salem Dehom ◽  
Synnove Knutsen ◽  
Khaled Bahjri ◽  
David Shavlik ◽  
Keiji Oda ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Renal Transplant ◽  
Racial Differences ◽  
Cox Regression ◽  
Fine Particulate Matter ◽  
Ambient Air ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk

Ambient air pollutants are known risk factors for cardiovascular disease (CVD) morbidity and mortality with significant racial disparities. However, few studies have explored racial differences among highly susceptible subpopulations, such as renal transplant recipients (RTRs). Despite improvements in quality of life after transplantation, CVD remains the major cause of mortality, especially among Black recipients. This study aimed to evaluate potential racial differences in the association between long-term levels of PM2.5 and the risk of all-cause, total CVD, and coronary heart disease (CHD) mortality among RTRs. This retrospective study consists of 93,857 non-smoking adults who received a renal transplant between 2001 and 2015. Time-dependent Cox regression was used to assess the association between annual concentrations of PM2.5 and mortality risk. In the multivariable-adjusted models, a 10 μg/m3 increase in ambient PM2.5 levels found increased risk of all-cause (HR = 3.45, 95% CI: 3.08–3.78), CVD (HR = 2.38, 95% CI: 1.94–2.92), and CHD mortality (HR = 3.10, 95% CI: 1.96–4.90). Black recipients had higher risks of all-cause (HR = 4.09, 95% CI: 3.43–4.88) and CHD mortality (HR = 6.73, 95% CI: 2.96–15.32). High levels of ambient PM2.5 were associated with all-cause, CVD, and CHD mortality. The association tended to be higher among Black recipients than non-Blacks.

scholarly journals FC 125DIURETIC USE IS  ASSOCIATED WITH INCREASED RISK FOR POSTTRANSPLANTATION DIABETES MELLITUS IN RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sara Sokooti Oskooei ◽  
Sok Cin Tye ◽  
Rianne M. Douwes ◽  
Hiddo Lambers Heerspink ◽  
Stephan Bakker
Keyword(s):  
Diabetes Mellitus ◽  
Renal Transplant ◽  
Cox Regression ◽  
Loop Diuretics ◽  
Renal Transplant Recipients ◽  
Regression Analyses ◽  
Transplant Recipients ◽  
Prospective Longitudinal Study ◽  
Increased Risk ◽  
Prospective Longitudinal

Abstract Background and Aims Posttransplantation diabetes Mellitus (PTDM) is one of the major medical problems in renal transplant recipients (RTRs). Diuretic-induced hyperglycemia and diabetes have been described in the general population. We aimed to investigate whether diuretics also increase PTDM risk in RTRs. Method We included 486 stable outpatient RTRs (with a functioning graft ≥1 year) without diabetes from a prospective longitudinal study (the Transplantlines Food and Nutrition Study [NCT02811835]). Participants were classified as diuretic users and non-diuretic users based on their medication use recording at baseline. PTDM was defined according the American Diabetes Association’s diagnostic criteria for diabetes. Multivariable Cox proportional-hazards regression analyses were performed to assess the prospective association between diuretic use and the risk of PTDM development. Results Median time since transplantation was 5.4 (2.0-12.2) years and 168 (35%) RTRs were taking diuretics. After 5.2 (IQR, 4.0 5.9) years of follow up, 54 (11%) RTRs developed PTDM. In Kaplan-Meier (log-rank test, p<0.001) and Cox regression analyses, diuretic use was found to be associated with incident PTDM after adjustment for age, sex, fasting plasma glucose (FPG), and HbA1c (hazard ratio[HR] 3.28, 95% CI 1.84-5.83; p<0.001). The association remained independent of further adjustment for potential confounders, including lifestyle, use of other medication, kidney function, transplantation-specific parameters, BMI, lipids, and blood pressure. Exploratory analyses further indicates that, in Cox regression analyses, both thiazide (n=74) and loop diuretics (n=76) as two main types of diuretics used among RTRs appeared to be associated with the development of PTDM, independent of age, sex, FPG, and HbA1c ([HR 2.70, 95% CI 1.24-5.29; p=0.012], and [HR 5.08, 95% CI 2.49-10.34; p<0.001], respectively). Conclusion This study demonstrates that diuretics overall, associated with the risk of developing PTDM in RTRs, independent of established risk factors for PTDM development. The association was consistent for thiazide and loop diuretics.

scholarly journals Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vatsa Dave ◽  
Kevan R. Polkinghorne ◽  
Khai Gene Leong ◽  
John Kanellis ◽  
William R. Mulley
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Renal Transplant ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Post Transplant ◽  
Increased Risk

Abstract The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients.

scholarly journals CD8+ T CELL SENESCENCE IS A DISTINCT IMMUNOLOGICAL STATE THAT IDENTIFIES LONG-TERM RENAL TRANSPLANT RECIPIENTS AT INCREASED RISK OF FUTURE MALIGNANCY

2020 ◽  
Vol 104 (S3) ◽  
pp. S106-S106
Author(s):  
Matthew J. Bottomley ◽  
Suzanne Bezstarosti ◽  
Eleni Ieremiah ◽  
Joanna Hester ◽  
Fadi Issa ◽  
...  
Keyword(s):  
T Cell ◽  
Renal Transplant ◽  
Cd8 T Cell ◽  
Cell Senescence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk ◽  
T Cell Senescence

scholarly journals Urinary Excretion of 6-Sulfatoxymelatonin, the Main Metabolite of Melatonin, and Mortality in Stable Outpatient Renal Transplant Recipients

2020 ◽  
Vol 9 (2) ◽  
pp. 525 ◽  
Author(s):  
Anna van der Veen ◽  
Isidor Minović ◽  
Martijn van Faassen ◽  
Antόnio W. Gomes-Neto ◽  
Stefan P. Berger ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Renal Disease ◽  
Urinary Excretion ◽  
Cox Regression ◽  
Renal Transplant Recipients ◽  
Healthy Controls ◽  
Transplant Recipients ◽  
Stage Renal Disease ◽  
End Stage

Melatonin is a multifaceted hormone which rises upon the onset of darkness. Pineal synthesis of melatonin is known to be disturbed in patients with end-stage renal disease, but it is not known if its production is restored to normal after successful renal transplantation. We hypothesized that urinary excretion of 6-sulfatoxymelatonin, the major metabolite of melatonin, is lower in renal transplant recipients (RTRs) compared to healthy controls and that this is associated with excess mortality. Urinary 6-sulfatoxymelatonin was measured via LC-MS/MS in 701 stable outpatient RTRs and 285 healthy controls. Median urinary 6-sulfatoxymelatonin in RTR was 13.2 nmol/24 h, which was 47% lower than in healthy controls. Urinary 6-sufatoxymelatonin appeared undetectable in the majority of 36 RTRs with diabetic nephropathy as primary renal disease. Therefore, this subgroup was excluded from further analyses. Of the remaining 665 RTRs, during 5.4 years of follow-up, 110 RTRs died, of whom 38 died due to a cardiovascular cause. In Cox-regression analyses, urinary 6-sulfatoxymelatonin was significantly associated with all-cause mortality (0.60 (0.44–0.81), p = 0.001) and cardiovascular mortality (0.49 (0.29–0.84), p = 0.009), independent of conventional risk factors and kidney function parameters. Based on these results, evaluation and management of melatonin metabolism could be considered for improvement of long-term outcomes in RTRs.

scholarly journals Serum Total Homocysteine and Cardiovascular Disease Occurrence in Chronic, Stable Renal Transplant Recipients: A Prospective Study

2000 ◽  
Vol 11 (1) ◽  
pp. 134-137 ◽  
Author(s):  
DIDIER DUCLOUX ◽  
GÉRARD MOTTE ◽  
BRUNO CHALLIER ◽  
ROGER GIBEY ◽  
JEAN-MARC CHALOPIN
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Renal Transplant ◽  
Cox Regression ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Creatinine Concentration ◽  
Cox Regression Analysis ◽  
Total Homocysteine

Abstract. Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardio-vascular risk factors. The mean follow-up was 21.2 ± 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 ± 9.5 μmol/L and median concentration was 19 μmol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 μmol/L). tHcy correlated negatively with folate concentration (r = -0.3; P <0.01). tHcy was closely related to creatinine concentration (r = 0.54; P < 0.001). Cardiovascular disease events (CVE) including death were observed in 30 patients (14.5%; 7.34 events per 1000 person-months of follow-up). Fasting tHcy values were higher in patients who experienced CVE (31.5 ± 10.3 versus 17.8 ± 7.5; P < 0.001). Cox regression analysis showed that tHcy was a risk factor for cardiovascular complications (relative risk [RR] 1.06; 95% confidence interval (95% CI), 1.04 to 1.09; P < 0.0001). This corresponds to an increase in RR for CVE of 6% per μmol/L increase in tHcy concentration. Age (RR 1.55; 95% CI, 1.09 to 2.19; P < 0.01) and creatinine concentration (RR 1.34; 95% CI, 1.08 to 1.66; P < 0.01) were also independent predictor for CVE. This study demonstrates that elevated fasting tHcy is an independent risk factor for the development of CVE in chronic stable renal transplant recipients. Randomized, place-bo-controlled homocysteine studies of the effect of tHcy lowering on CVE rates are urgently required in this patient population.

Early postoperative C-terminal agrin fragment (CAF) serum levels predict graft loss and proteinuria in renal transplant recipients

2016 ◽  
Vol 54 (1) ◽  
Author(s):  
Dominik Steubl ◽  
Anna Vogel ◽  
Stefan Hettwer ◽  
Susanne Tholen ◽  
Peter B. Luppa ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Predictive Value ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Long Term Outcomes

AbstractC-terminal agrin fragment (CAF), cleavage product of agrin, was previously correlated with kidney function in renal transplant patients. This article studies the predictive value of CAF for long-term outcomes in renal transplant recipients.In this observational cohort study, serum CAF, creatinine and blood-urea-nitrogen (BUN) concentrations and eGFR (CKD-EPI) were assessed 1–3 months after transplantation in 105 patients undergoing kidney transplantation. Cox regression models were used to analyse the predictive value of all parameters concerning all-cause mortality (ACM), graft loss (GL), doubling of creatinine/proteinuria at the end of follow-up.Median follow-up time was 3.1 years. The mean concentrations were 191.9±152.4 pM for CAF, 176±96.8 μmol/L for creatinine, 12.6±6.2 mmol/L for BUN and 44.9±21.2 mL/min for CKD-EPI formula, respectively. In univariate analysis CAF and BUN concentrations predicted ACM (CAF: HR=1.003, 1.1-fold risk, p=0.043; BUN: HR=1.037, 1.3-fold risk, p=0.006). Concerning GL, CAF (HR=1.006, 3.1-fold risk, p<0.001), creatinine (HR=2.396, 2.6-fold risk, p<0.001), BUN (HR=1.048, 1.7-fold risk, p=0.001) and eGFR (CKD-EPI) (HR=0.941, 0.45-fold risk reduction, p=0.006) showed a statistically significant association. CAF was the only parameter significantly associated with doubling of proteinuria (HR=1.005, 1.7-fold risk, p<0.001). In multiple regression analysis (CAF only) the association remained significant for GL and doubling of proteinuria but not ACM.Early postoperative serum CAF appears to be a useful tool for the assessment of long-term outcomes in renal transplant recipients. Most importantly it represents a promising predictor for the development of proteinuria.

Sign in / Sign up

Export Citation Format

Share Document