J Korean Med Sci.  2010 May;25(5):706-711. 10.3346/jkms.2010.25.5.706.

Correlates of the Severity of Coronary Atherosclerosis in Long-term Kidney Transplant Patients

Affiliations
  • 1Department of Internal Medicine, Wonkwang University College of Medicine Sanbon Hospital, Gunpo, Korea.
  • 2Department of Medicine, Graduate School of Medicine, Yonsei University, Seoul, Korea.
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. khchoi6@yuhs.ac
  • 4Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 5The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.

Keyword

Coronary Artery Disease; Coronary Angiography; Kidney Transplantation

MeSH Terms

Adult
Comorbidity
Coronary Artery Disease/*diagnosis/*epidemiology
Female
Humans
Incidence
Kidney Transplantation/*statistics & numerical data
Korea/epidemiology
Male
Renal Insufficiency/*epidemiology/*surgery
Risk Assessment
Risk Factors
Statistics as Topic

Cited by  1 articles

Cardiovascular Diseases after Kidney Transplantation in Korea
Jong Cheol Jeong, Han Ro, Young-Hwan Hwang, Han Kyu Lee, Jongwon Ha, Curie Ahn, Jaeseok Yang
J Korean Med Sci. 2010;25(11):1589-1594.    doi: 10.3346/jkms.2010.25.11.1589.


Reference

1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999. 341:1725–1730.
Article
2. Fazelzadeh A, Mehdizadeh AR, Ostovan MA, Raiss-Jalali GA. Predictors of cardiovascular events and associated mortality of kidney transplant recipients. Transplant Proc. 2006. 38:509–511.
Article
3. Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman BR, Passamani E, Russell RO Jr, Alderman EL, Kouchoukas NT, Kaiser GC, Ryan TJ, Killip T, Fray D. Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest. 1983. 71:1854–1866.
Article
4. Joki N, Hase H, Takahashi Y, Ishikawa H, Nakamura R, Imamura Y, Tanaka Y, Saijyo T, Fukazawa M, Inishi Y, Nakamura M, Yamaguchi T. Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis. Int Urol Nephrol. 2003. 35:289–297.
Article
5. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999. 130:461–470.
6. Judkins MP. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967. 89:815–824.
7. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983. 51:606.
Article
8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005. 18:1440–1463.
Article
9. Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000. 11:1735–1743.
Article
10. Horl WH, Cohen JJ, Harrington JT, Madias NE, Zusman CJ. Atherosclerosis and uremic retention solutes. Kidney Int. 2004. 66:1719–1731.
11. Kasiske BL. Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med. 1988. 84:985–992.
Article
12. Chueh SC, Kahan BD. Dyslipidemia in renal transplant recipients treated with a sirolimus and cyclosporine-based immunosuppressive regimen: incidence, risk factors, progression, and prognosis. Transplantation. 2003. 76:375–382.
13. Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, Salem DN, Levey AS, Sarnak MJ. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol. 2004. 15:1307–1315.
14. Meier-Kriesche HU, Baliga R, Kaplan B. Decreased renal function is a strong risk factor for cardiovascular death after renal transplantation. Transplantation. 2003. 75:1291–1295.
15. Na KY, Kim CW, Song YR, Chin HJ, Chae DW. The association between kidney function, coronary artery disease, and clinical outcome in patients undergoing coronary angiography. J Korean Med Sci. 2009. 24:Suppl 1. S87–S94.
Article
16. Raj DS, Lim G, Levi M, Qualls C, Jain SK. Advanced glycation end products and oxidative stress are increased in chronic allograft nephropathy. Am J Kidney Dis. 2004. 43:154–160.
Article
17. Holdaas H, Fellstrom B, Cole E, Nyberg G, Olsson AG, Pedersen TR, Madsen S, Gronhagen-Riska C, Neumayer HH, Maes B, Ambuhl P, Hartmann A, Staffler B, Jardine AG. Long-term cardiac outcomes in renal transplant recipients receiving fluvastatin: the ALERT extension study. Am J Transplant. 2005. 5:2929–2936.
Article
18. Cofan F, Gilabert R, Zambon D, Nunez I, Ros E, Cofan M, Campistol JM, Bru C, Oppenheimer F. Effect of pravastatin treatment on the evolution of extracoronary atherosclerosis in renal transplant patients. Transplant Proc. 2002. 34:384–388.
Article
19. Wilson SH, Simari RD, Best PJ, Peterson TE, Lerman LO, Aviram M, Nath KA, Holmes DR Jr, Lerman A. Simvastatin preserves coronary endothelial function in hypercholesterolemia in the absence of lipid lowering. Arterioscler Thromb Vasc Biol. 2001. 21:122–128.
Article
20. Florijn KW, Chang PC, van der Woude FJ, van Bockel JH, van Saase JL. Long-term cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease patients after renal transplantation. Transplantation. 1994. 57:73–81.
Article
21. Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ. Cardiovascular disease after renal transplantation. J Am Soc Nephrol. 1996. 7:158–165.
Article
22. Roeske WR, Savage RM, O'Rourke RA, Bloor CM. Clinicopathologic correlations in patients after myocardial infarction. Circulation. 1981. 63:36–45.
Article
23. Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990. 81:1161–1172.
Article
24. Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation. 1993. 87:755–763.
Article
25. Anversa P, Zhang X, Li P, Capasso JM. Chronic coronary artery constriction leads to moderate myocyte loss and left ventricular dysfunction and failure in rats. J Clin Invest. 1992. 89:618–629.
Article
26. Moe SM, O'Neill KD, Fineberg N, Persohn S, Ahmed S, Garrett P, Meyer CA. Assessment of vascular calcification in ESRD patients using spiral CT. Nephrol Dial Transplant. 2003. 18:1152–1158.
Article
27. Ducloux D, Motte G, Challier B, Gibey R, Chalopin JM. Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study. J Am Soc Nephrol. 2000. 11:134–137.
Article
28. Arnadottir M, Hultberg B, Vladov V, Nilsson-Ehle P, Thysell H. Hyperhomocysteinemia in cyclosporine-treated renal transplant recipients. Transplantation. 1996. 61:509–512.
29. Franke S, Muller A, Sommer M, Busch M, Kientsch-Engel R, Stein G. Serum levels of total homocysteine, homocysteine metabolites and of advanced glycation end-products (AGEs) in patients after renal transplantation. Clin Nephrol. 2003. 59:88–97.
Article
30. Cueto-Manzano AM, Morales-Buenrostro LE, Gonzalez-Espinoza L, Gonzalez-Tableros N, Martin-del-Campo F, Correa-Rotter R, Valera I, Alberu J. Markers of inflammation before and after renal transplantation. Transplantation. 2005. 80:47–51.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr