scholarly journals Cardiovascular risk assessment by Framingham score pre and post kidney transplant

2016 ◽  
Vol 19 (2) ◽  
pp. 13-17
Author(s):  
Marcos Vinicius de Sousa ◽  
Nayara Tenório ◽  
Carla Feitosa do Valle ◽  
Marilda Mazzali
Keyword(s):  
Risk Factors ◽  
Total Cholesterol ◽  
Kidney Transplant ◽  
Risk Score ◽  
Graft Loss ◽  
Left Ventricular ◽  
Inclusion Criteria ◽  
Kidney Transplants ◽  
Post Transplant ◽  
Significant Difference

Cardiovascular mortality is the main cause for graft loss after a successful kidney transplant. Purpose: To analyze the risk for cardiovascular events by the Framinghan risk score, pre and 1-year after kidney transplant. Methods: Retrospective study analyzing the transplant Unit database of kidney transplants performed from January 2010 to January 2012. Inclusion criteria: age >18 years old, functioning graft 12 months post-transplant. Exclusion criteria: patient death or graft loss within the first year after transplant. Demographic and laboratory data were collected pre and 12 months post-transplant; the Framinghan risk score was calculated at those points. Pre-transplant echocardiogram was also analyzed. Results: From 230 kidney transplants performed during the studied period, 167 fulfilled the inclusion criteria. Sixty-three were excluded due to death or graft loss (n=29) or insufficient data for analysis. In the majority, the studied group was male (64.6%), mean age of 47.9+11.1 years old and recipients from deceased donor (97%). Echocardiogram showed a 67.5 +6.6% ejection fraction, left ventricular hypertrophy in 98%, with a low incidence of valvar calcification (2.5%). Framinghan score was similar pre and after transplant (16.4+14.9 vs. 18.3 +17.2, p=ns). However, analysis of isolated parameters showed a significant difference pre and after transplant. While pre-transplant risk factors were high blood pressure, lower HDL cholesterol, and active smoking, post-transplant risk factors were the occurrence of diabetes, higher total cholesterol that required anti-hypertensive therapy. Conclusion: the early after transplant results, recovery of renal function, hematocrit and nutritional levels in the body weight gain usually along with impaired metabolic parameters, mainly total cholesterol, triglyceryde and uric acid maintained a similar Framinghan risk score as pre-transplant levels.

MO940ACUTE REJECTION IN KIDNEY RETRANSPLANTATION: RISK FACTORS AND IMPACT IN GRAFT SURVIVAL

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Rita Leal ◽  
Clara Pardinhas ◽  
Luís Rodrigues ◽  
Maria Guedes Marques ◽  
Lidia Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Failure ◽  
Graft Loss ◽  
First Year ◽  
Post Transplant ◽  
Increased Risk

Abstract Background and Aims Kidney retransplantation confers a robust survival benefit over dialysis in selected patients and recent data has shown second graft outcomes similar to those of a first graft. However, the management of these patients is challenging, particularly due to allosensitization and an increased risk of acute rejection, which are related with poorer graft survival. The recognition of risk factors to acute rejection, dependent on the first and second graft, might help us to personalize standard care and achieve similar graft survival rates to patients with a first transplant. Our aim was to identify risk factors to second graft acute rejection, and the impact of acute rejection in graft failure. Method We performed a retrospective, longitudinal study including all patients submitted to a second kidney transplant between January 2008 and December 2019, excluding patients with more than 2 grafts or multi-organ transplant. Demographic, clinical and histocompatibility data from the donor and receptor were collected from our unit database. Delayed graft function was defined as the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up was defined at 1st June 2020 for functioning grafts or at graft failure, with a mean time of 94±42 months. Results We included 109 patients of which 70 males (64%), mostly Caucasian (97%), with a mean age of 43±12 years at second kidney transplant. The main causes of end stage renal disease were glomerular disease (37%), undetermined cause (34%), and urological pathology (15%). First kidney transplant was performed before the year 2010 in 95 patients (87%). The median time of first graft survival was 75 months (IQR 58.5-91.4) and the main causes of first graft loss were chronic allograft nephropathy (N=62, 70.5%) and 11 patients (12.5%) presented primary disfunction due to surgical/vascular complications. During follow-up, 20 patients (18%) presented biopsy proven acute rejection: 3 patients borderline changes, 10 patients T cell mediated and 7 patients antibody mediated, the majority during the first-year post-transplant (N=17, 85%). The risk factors for second graft rejection are summarized in table 1. First year graft survival of the second transplant was 90% and survival at follow up was 72.5% (N=79). Acute rejection was an important risk factor for graft loss (OR 6.548 (95%CI[2.292 - 18.703]), p<0.01). Conclusion Worst outcomes in first kidney transplant, such as acute rejection, primary dysfunction and lower graft survival were related with an increased risk of acute rejection in second graft outcomes, and consequently a higher risk of graft failure.

Effect of Tobacco on Lipoprotein Profile: A Comparative study among Smokers and Chewers

2021 ◽  
pp. 4973-4976
Author(s):  
Roshan Kumar Jha ◽  
Ranjit S. Ambad ◽  
Priya Koundal ◽  
Akansha Singh
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Total Cholesterol ◽  
Sample Processing ◽  
Exclusion Criteria ◽  
Future Studies ◽  
Area Of Interest ◽  
Significant Difference ◽  
The Difference

It has been proved that tobacco is one of the cholesterol dependent risk factors pathogenically, and in addition with other risk factors it may lead to coronary heart disease. Thus, a strong interaction exists between hypercholesterolemia and tobacco ingesting in the genesis of coronary heart disease. The aim of this study was to study the effect of tobacco smoking and chewing and compare its effect on lipoproteins. 60 subjects were included in the study, and were grouped into 3 three groups, tobacco smokers, tobacco chewers and tobacco non-abusers. Each group comprises 20 participants: selected on the basis of inclusion and exclusion criteria. Proper sampling and sample processing methods were employed to evaluate lipid profile. Total cholesterol and triglycerides levels were increased in smokers in comparison to non-smokers/non-chewers, and the differences were significant p<0.0001. HDL level was decreased in smokers as compared to non-smokers/non-chewers and the difference was statistically significant p<0.0001. Total cholesterol and LDL levels were increased in smokers in comparison to chewers. HDL level was decreased in chewers as compared to chewers. There was no significant association in any of the parameters. Present study observed increased and significant p<0.0001 differences in levels of total cholesterol and triglycerides while, HDL levels were decreased significantly p<0.0001, and also observed there was no significant difference among tobacco smokers and chewers. This may be a new area of interest for future studies.

scholarly journals Transplantation: Polyomavirus Nephropathy and the Risk of Specific Immunosuppression Regimens

2006 ◽  
Vol 6 ◽  
pp. 412-528 ◽  
Author(s):  
Christine Wu ◽  
Parmjeet Randhawa ◽  
Jerry McCauley
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Transplant Patient ◽  
Graft Loss ◽  
Bk Virus ◽  
Therapeutic Monitoring ◽  
Kidney Transplant Patient ◽  
Bk Polyomavirus ◽  
Specific Immunosuppression

BK virus is ubiquitously present in the latent state in humans, and awareness of the importance of BK polyomavirus is emerging among the kidney transplant community. First discovered in 1971 in the urine of a renal transplant recipient, BK virus nephropathy (BKVN) has come to be recognized as a significant cause of genitourinary disease and potential graft loss in the kidney transplant patient. In this review, we discuss the risk factors, available methods of diagnosis and therapeutic monitoring, and current approaches to therapy of BKVN.

scholarly journals 329 Heart failure predictive value of the electric risk score in patients suffering from thalassemia major

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Elisa Tomarelli ◽  
Federica Moscucci ◽  
Anna Annunziata Losardo ◽  
Pellegrina Pugliese ◽  
Mauro Schina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Ventricular Hypertrophy ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Myocardial Damage ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
P Value ◽  
Iron Chelation Therapy

Abstract Aims Complications associated with iron accumulation were highly recurrent in thalassemia patients, who underwent frequent blood transfusions, in particular hemosiderotic cardiomyopathy which could lead to heart failure and arrhythmias. Nowadays, the better iron chelation therapy has improved cardiovascular morbidity in these patients; nevertheless, mild impairment should be seek for and eventually treated. The objective of our study was to evaluate the possibility of using early electrocardiographic markers of myocardial damage and predictors of mortality, such as the Electric Risk Score (ERS). Methods and results 73 patients with thalassemia major were enrolled in this study, which were divided into two groups, with 45 years old as cut off. Anamnestic, clinical, electrocardiographic, and echocardiographic data were collected. From ECG, ERS was obtained. over 45 yrs-old group of pts, in addition to a predictable increase in the prevalence of traditional cardiovascular risk factors and drug intake, an alteration of the QRS-T angle (14[30] vs. −4[28], p value: &lt;0.0001) and an increased prevalence of left ventricular hypertrophy (2.88 ± 0.86 vs. 2.40 ± 0.57 p value: &lt;0.05) were found. In patients taking drugs with possible interactions with the ventricular repolarization phase, there is a slight increase in the QT interval, left ventricular hypertrophy and a reduction in Tpeak-Tend (Table 1). Electrocardiographic values in groups of patients with different age groups who are taking therapies that can affect QT. The echocardiogram revealed an increase in the end-diastolic diameter of the right ventricle (26 ± 3 vs. 28 ± 3 mm, P-value: 0.05) in the group of patients over the age of 45, a decrease in the acceleration time of the pulmonary systolic flow (138 ± 25 vs. 125 ± 13 ms, P-value: 0.04) and TAPSE (25 ± 3 vs. 22 ± 4 mm, P-value: 0.002). Conclusions From the data in our study it emerged that an appropriate iron-chelation therapy is able to effectively counteract the hemosiderotic cardiomyopathy of thalassemic patients so as to detect electro- and echocardiographic anomalies only in patients of more advanced age, a result that we think both the consequence, not so much of iron overload, but of an increase in the prevalence of age- and gender-related cardiovascular risk factors. The initial changes in cardiac electromechanics, which can be assessed with the aforementioned methods, we believe, can become a very early sign of specific myocardial damage. 329 Figure 1Electrical risk score parameters.

scholarly journals Obese and Type 2 Diabetic Youth Have Increased Forward and Backward Wave Reflections

2020 ◽  
Author(s):  
Andrew H. Tran ◽  
Thomas R. Kimball ◽  
Philip R. Khoury ◽  
Lawrence M. Dolan ◽  
Elaine M. Urbina
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Linear Models ◽  
Left Ventricular ◽  
Wave Reflections ◽  
Significant Difference ◽  
Backward Wave

Objective: Pulse wave analysis estimates arterial wave reflections relating to left ventricular dysfunction and cardiovascular event risk in adults. Forward and backward waves (Pf and Pb) may improve risk stratification for cardiovascular events. Data in youth are lacking. We hypothesized that a significant difference in wave reflections would be identified in young subjects with adverse cardiovascular risk factors. Approach and Results: Vital signs and labs were obtained in 551 patients aged 10 to 24 years who were lean (L=199), obese (O=173), or had type 2 diabetes (T=179). Wave separation was performed. Differences in cardiovascular risk factors and wave reflections were assessed using ANOVA. General linear models were constructed to elucidate independent predictors of wave reflections. O and T subjects had an adverse cardiovascular risk profile versus L. O and T subjects had higher Pf and Pb versus L ( P ≤0.05). When adjusted for adiposity and other cardiovascular risk factors, reflection magnitude increased from L to O to T with higher T versus L values ( P ≤0.05) and near-significant O versus L values ( P =0.06). Adiposity and blood pressure were major determinants of wave reflections. Pb influenced log left ventricular mass index, log E/e′, and log composite carotid intima-media thickness. Conclusions: Adolescents and young adults with obesity and type 2 diabetes have altered forward and backward wave reflections versus lean controls related to adiposity, BP, and insulin levels. These parameters may help risk stratify patients with adverse cardiovascular risk factors.

scholarly journals Cardiovascular Risk Distribution in a Contemporary Polish Collective

2020 ◽  
Vol 17 (9) ◽  
pp. 3306
Author(s):  
Anita Liput-Sikora ◽  
Anna Cybulska ◽  
Wiesława Fabian ◽  
Anna Fabian-Danielewska ◽  
Marzanna Stanisławska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Family History ◽  
Total Cholesterol ◽  
Positive Family History ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Medical Documentation ◽  
Significant Difference

The aim of this study was to assess the prevalence of selected risk factors for cardiovascular disease (hypertension, overweight, obesity, carbohydrate metabolism disorders, a positive family history, a lack of physical activity), and to estimate the risk of a cardiovascular incident according to the Systematic Coronary Risk Evaluation (SCORE) algorithm for patients aged 35, 40, 45, 50, and 55 years, included in a primary-care prevention program, with regard to selected variables (sex and age brackets). The study sample consisted of 2009 subjects, 63% of whom were women. The largest group was the group of 35-year-olds (27%). The research method was the analysis of medical documentation of primary-care patients living in West Pomerania included in the Program of Prevention and Early Detection of Cardiovascular Disease of the National Health Fund. We collected data concerning risk factors for cardiovascular disease, blood pressure, anthropometric measurements (arm circumference, waist circumference, height, weight), body mass index (BMI), and the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting glucose, as well as the SCORE results. Men more often than women were overweight and obese, had hyperglycemia, and had elevated levels of total cholesterol, LDL cholesterol, and triglycerides (p < 0.001). There was also a statistically significant difference in the odds of a cardiovascular incident (p < 0.001)—the SCORE results obtained by men were higher. Men require special preventive measures in order to reduce their risk factors for cardiovascular disease, especially hypertension, dyslipidemia, diabetes, overweight, obesity, smoking, and a positive family history.

Medicolegal Reflections about a Case of Cardiac Death after Renal Transplantation

2007 ◽  
Vol 30 (7) ◽  
pp. 649-655
Author(s):  
M. Di Paolo ◽  
B. Guidi
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Transplant ◽  
Cardiac Death ◽  
Graft Loss ◽  
Left Ventricular ◽  
Renal Transplant Recipients ◽  
Post Transplantation ◽  
Coronary Syndrome ◽  
Traditional Risk Factors

Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also “non traditional” risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system. The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died. The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation. (Int J Artif Organs 2007; 30: 649–55)

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