Back to Search
Start Over
A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal Transplantation
- Source :
- Clinical Journal of the American Society of Nephrology. 10:471-479
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- The role of reversibility of nontraditional risk factors, like inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined.The longitudinal relationship between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32±10 years) with stage 5 CKD maintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation.Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis (average=0.9±0.2 mm) was higher (P0.001) than in well matched healthy controls (0.6±0.1 mm) and reduced substantially (-22%; 95% confidence interval, -24% to -20%) after transplantation (P=0.001). GFR (multivariable-adjusted β=0.23; P0.001), C-reactive protein (β=0.15; P0.001), and fibroblast growth factor 23 (β=0.28; P0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent correlates of simultaneous changes in intima media thickness (C-reactive protein: β=0.25; fibroblast growth factor 23: β=0.26; P0.001 for both) after renal transplantation. The evolution of intima media thickness after transplantation was largely independent of classic risk factors, including BP, LDL cholesterol, and insulin resistance, as measured by homeostatic model assessment.Intima media thickness improves after renal transplantation. Such an improvement associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation, in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and CKD-mineral bone disorder.
- Subjects :
- Adult
Carotid Artery Diseases
Male
Fibroblast growth factor 23
medicine.medical_specialty
Pathology
Epidemiology
medicine.medical_treatment
Blood Pressure
Critical Care and Intensive Care Medicine
Carotid Intima-Media Thickness
Phosphates
Young Adult
Internal medicine
medicine
Humans
Longitudinal Studies
Postoperative Period
Dialysis
Kidney transplantation
Inflammation
Transplantation
biology
business.industry
C-reactive protein
Immunosuppression
Original Articles
Arteriosclerosis
medicine.disease
Kidney Transplantation
Fibroblast Growth Factors
Bone Diseases, Metabolic
Fibroblast Growth Factor-23
C-Reactive Protein
Intima-media thickness
Parathyroid Hormone
Nephrology
Preoperative Period
Cardiology
biology.protein
Kidney Failure, Chronic
Calcium
Female
Insulin Resistance
business
Biomarkers
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 15559041
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Clinical Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....014fb432365abb6c2d19d363274893c5