R LEWIS1,2,3, G WONG2, M VUCAK-DZUMHUR4, G ELDER4,5
1School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia, 2Centre for Kidney Research, Children’s Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia, 3University of Western Australia, Medical School, Sir Charles Gairdner Hospital Unit, Perth, Australia, 4Depatment of Renal Medicine, Westmead Hospital, Australia, 5Garvan Institute of Medical Research, Darlinghurst, Australia
Aim: to investigate whether abdominal aortic calcification (AAC) at time of kidney and simultaneous pancreas-kidney (SPK) transplantation predicts cardiovascular (CV) events and patient survival.
Background: Despite improved renal function , cardiovascular events and mortality remain many times the population mean after transplantation..
Methods: This prospective cohort study assessed 413 kidney and 213 SPK 1st transplant recipients without known CV disease. Within 4 weeks of transplant, lateral spine radiographs including the abdominal aorta were scored for AAC using the Kaupilla 24-point scale. The primary outcomes were incident CVD, comprising myocardial infarction, stroke or peripheral vascular disease, and all-cause mortality.
Results: The mean age was 44 ± 12 years with 277 (44%) having AAC. After a median follow up of 65 months (IQR 29-107 months), 47 transplant recipients experienced 1 or more cardiovascular events and 60 died from any cause. In restricted cubic spline regression, a linear dose response was seen with increasing AAC scores. After adjustment for age, diabetes, gender, dialysis vintage and transplant type, each 1 point increase in AAC predicted a 7-9% increase in the multivariable-adjusted relative hazards for CV events and all-cause mortality (HR 1.07 95%CI [1.02-1.12], P=0.005 and HR1.09 95%CI [1.04-1.12], P<0.001, respectively). Transplant recipients with AAC ≥8 had 3.3-3.5 times the relative hazards of CV events or death vs. recipients without AAC (HR 3.46 [1.53-7.82] and HR 3.36 [1.71-6.60], respectively.
Conclusions: AAC predicts CV events and mortality in kidney and SPK transplant patients and may identify transplant recipients in whom intensive interventions could reduce cardiovascular risk.
Grahame Elder is a renal physician, whose principal interest is in bone and mineral metabolism, particularly resulting from Chronic Kidney Disease and following transplantation. He is a staff specialist in the Department of Renal Medicine, Westmead Hospital Sydney, clinical associate professor University of Sydney and clinical professor University of Notre Dame, visiting specialist in the Bone and Calcium Clinic at St Vincent’s Hospital Sydney and member of the Osteoporosis and Bone Biology Division at the Garvan Institute for Medical Research, Sydney. He has been a work group member for the CARI guidelines and the KDIGO CKD-MBD guidelines.