Aortic Stiffness and Central Wave Reflections Predict Outcome in Renal Transplant Recipients

Although renal transplantation improves survival, cardiovascular morbidity and mortality remain significantly elevated compared with nonrenal populations. The negative impact of traditional, uremia-related, and transplantation-related risk factors in this process remains, however, largely unexplored. Surrogate markers such as aortic stiffness and central wave reflections may lead to more accurate cardiovascular risk stratification, but outcome data in renal transplant recipients are scarce. We aimed to establish the prognostic significance of these markers for fatal and nonfatal cardiovascular events in renal transplant recipients. Carotid-femoral pulse wave velocity, central augmentation pressure, and central augmentation index were measured in a cohort of 512 renal transplant recipients using the SphygmoCor system. After a mean follow-up of 5 years, 20 fatal and 75 nonfatal cardiovascular events were recorded. Using receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.718 (95% CI 0.659–0.776) for pulse wave velocity, 0.670 (95% CI 0.604–0.736) for central augmentation pressure, and 0.595 (95% CI 0.529–0.660) for central augmentation index. When we accounted for age, gender, and C-reactive protein in Cox-regression analysis, pulse wave velocity (hazard ratio: 1.349 per 1 SD increase; 95% CI 1.104–1.649; P=0.003) and central augmentation pressure (hazard ratio: 1.487 per 1 SD increase; 95% CI 1.219–1.814; P<0.001) remained independent predictors of outcome. Aortic stiffness and increased wave reflections are independent predictors of cardiovascular events in renal transplant recipients. As single parameter of wave reflection, central augmentation pressure was better than central augmentation index. Combined measurement of pulse wave velocity and central augmentation pressure may contribute to an accurate cardiovascular risk estimation in this heterogeneous population.

[1]  M. Jadoul,et al.  The relation between hypomagnesaemia and vascular stiffness in renal transplant recipients. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[2]  E. Coche,et al.  Serum fetuin-A levels are associated with vascular calcifications and predict cardiovascular events in renal transplant recipients. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[3]  A. Kribben,et al.  Pulse wave velocity predicts mortality in renal transplant patients , 2010, European journal of medical research.

[4]  Yasmin,et al.  Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’ , 2010, European heart journal.

[5]  T. Hansen,et al.  Risk prediction is improved by adding markers of subclinical organ damage to SCORE. , 2010, European heart journal.

[6]  Michael J. Pencina,et al.  Arterial Stiffness and Cardiovascular Events: The Framingham Heart Study , 2010, Circulation.

[7]  A. Kribben,et al.  Effect of new‐onset diabetes mellitus on arterial stiffness in renal transplantation , 2008, Transplant international : official journal of the European Society for Organ Transplantation.

[8]  M. Safar,et al.  Aortic stiffness of kidney transplant recipients correlates with donor age. , 2008, Journal of the American Society of Nephrology : JASN.

[9]  W. van Biesen,et al.  Arterial stiffness and wave reflections in renal transplant recipients. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[10]  H. Struijker‐Boudier,et al.  Abridged version of the expert consensus document on arterial stiffness , 2007 .

[11]  A. Dominiczak,et al.  2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) , 2007, European heart journal.

[12]  Piotr Ponikowski,et al.  2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, European heart journal.

[13]  H. Struijker‐Boudier,et al.  Expert consensus document on arterial stiffness: methodological issues and clinical applications. , 2006, European heart journal.

[14]  W. Zidek,et al.  Impaired Renal Allograft Function is Associated with Increased Arterial Stiffness in Renal Transplant Recipients , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[15]  C. Beaumont,et al.  Anemia after Late Introduction of Sirolimus May Correlate with Biochemical Evidence of a Chronic Inflammatory State , 2005, Transplantation.

[16]  Yasmin,et al.  Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). , 2005, Journal of the American College of Cardiology.

[17]  J. Chudek,et al.  Association between chronic periodontal disease and left ventricular hypertrophy in kidney transplant recipients. , 2005, Transplantation.

[18]  P. Verdonck,et al.  Noninvasive Assessment of Local Pulse Pressure: Importance of Brachial-to-Radial Pressure Amplification , 2005, Hypertension.

[19]  R. Vanholder,et al.  New insights in uremic toxicity. , 2005, Contributions to nephrology.

[20]  J. Schold,et al.  Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[21]  M. Haberal,et al.  Post‐transplant C‐reactive protein monitoring can predict chronic allograft nephropathy , 2004, Clinical transplantation.

[22]  S. Aakhus,et al.  Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5‐yr follow‐up , 2004, Clinical transplantation.

[23]  M. Raftery,et al.  Pretransplantation levels of C-reactive protein predict all-cause and cardiovascular mortality, but not graft outcome, in kidney transplant recipients. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[24]  C. Ferro,et al.  Central aortic pressure augmentation in stable renal transplant recipients. , 2002, Kidney international.

[25]  O. Wagner,et al.  Evaluation of turbidimetric high-sensitivity C-reactive protein assays for cardiovascular risk estimation. , 2001, Clinical chemistry.

[26]  M E Safar,et al.  Arterial Wave Reflections and Survival in End-Stage Renal Failure , 2001, Hypertension.

[27]  F. Port,et al.  Survival improvement among patients with end-stage renal disease: trends over time for transplant recipients and wait-listed patients. , 2001, Journal of the American Society of Nephrology : JASN.

[28]  P. Ducimetiere,et al.  Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients , 2001, Hypertension.

[29]  J. Blacher,et al.  Impact of aortic stiffness on survival in end-stage renal disease. , 1999, Circulation.

[30]  M. Karamanoglu,et al.  An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. , 1993, European heart journal.

[31]  W. van Biesen,et al.  Prognostic value of aortic stiffness and calcification for cardiovascular events and mortality in dialysis patients: outcome of the calcification outcome in renal disease (CORD) study. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[32]  Eld,et al.  COMPARISON OF MORTALITY IN ALL PATIENTS ON DIALYSIS , PATIENTS ON DIALYSIS AWAITING TRANSPLANTATION , AND RECIPIENTS OF A FIRST CADAVERIC TRANSPLANT , 2000 .