2010 - TTS International Congress


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Complications Cardiovascular

31.11 - 5-year cardiovascular risk analysis in transplant patients

Presenter: Jesus, Bustamante Bustamante, Valladolid, Spain
Authors: Sanz Ballesteros S., Pascual Núñez P., Mendiluce Herrero A., Perez Diaz V., Bustamante Bustamante J.

5-YEAR CARDIOVASCULAR RISK ANALYSIS IN TRANSPLANT PATIENTS

COMPLICATIONS - CARDIOVASCULAR

S. Sanz ballesteros, P. Pascual núñez, A. Mendiluce herrero, V. Perez diaz, J. Bustamante bustamante
Nephrology, Hospital Clinico Universitario, valladolid/SPAIN

Body: INTRODUCTION Cardiovascular disease is the first cause of death following a kidney transplant. The incidence of cardiovascular disease is between two and five times that observed in the general population, due partly to the high prevalence of cardiovascular risk factors and also to drugs which alter the cardiovascular profile and worsen the survival rate of such patients. MATERIAL AND METHODS A 5-year prospective observational study of cardiovascular disease in transplant patients in Valladolid Clinical Hospital. The causes of cardiovascular disease were analysed together with long-term cardiovascular risk factors. RESULTS The first cause of graft loss at 5 years was the patient’s death, with the transplanted kidney functioning, due to a cardiovascular disorder. The incidence of cardiovascular events was 16.54%, with 21.8% suffering more than one event and 18% dying as a result of this through AMI. Most of the cardiovascular events were of cardiac origin, ischemic heart disease (69.7%) being the most common cause (AMI 39.1 %, angina 30.4%). 21.7% suffered some cardiac insufficiency event, whereas auricular fibrillation and dilated miocardiopathy accounted for 8.7%. These events mainly occurred at two moments of the study: 30% at six months and the remaining 30% at 5 years. Arterial hypertension accounted for 74.8% of pre-transplant episodes, increasing to 78.9% at 5 years. 77% needed more than one drug, the most commonly prescribed being calcium antagonists (26.42%) and ACEIs (23.42%). The prevalence of pre-transplant diabetes mellitus was 11.5% and 21.1% at 5 years. 65.2% were receiving treatment with insulin and 17.4% with oral antidiabetic drugs. The pre-transplant prevalence of dyslipemia was 23.1% and 57.8% at 5 years. Hypercholesterolemia represented 40.5% and hypertriglyceridemia 37.8%. Although 82% were treated with statins, only 41% were controlled. Obesity had a pre-transplant prevalence of 10% and 24.7% at 5 years. 28.5% reported being pre-transplant smokers and 16.5% at 5 years, whilst 42% of the patients had given up the habit. 92.9% of the patients who suffered a cardiovascular event over the 5 years presented with kidney disorder after a year, characterised by glomerular filtration lower than 60ml/min. Renal disorder was associated with a higher prevalence of obesity, arterial hypertension and dyslipemia at 5 years. Obesity risk after 5 years with kidney disorder was 3 times greater, arterial hypertension 1.25 and dyslipemia 1.76. CONCLUSIONS The most frequent cardiovascular complication was ischemic heart disease. Given that 30% of ischemic events appear in the first months, it is necessary to assess cardiovascular history as well as to step up efforts to control post-transplant cardiovascular risk factors. Arterial hypertension represented the most prevalent modifiable risk factor. The renal function of the transplant plays a relevant role in cardiovascular morbidity-mortality.

Disclosure: All authors have declared no conflicts of interest.


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