NDT Advance Access originally published online on March 30, 2006
Nephrology Dialysis Transplantation 2006 21(8):2282-2289; doi:10.1093/ndt/gfl095
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Renal transplant dysfunction—importance quantified in comparison with traditional risk factors for cardiovascular disease and mortality
1 Department of Medical Sciences, Uppsala University, Uppsala, Sweden, 2 Department of Biochemistry, Tartu University, Tartu, Estonia, 3 Rikshospitalet, Oslo, Norway, 4 University of Glasgow, Glasgow, UK and 5 NOVARTIS, Basel, Switzerland
Correspondence and offprint requests to: Inga Soveri, MD, Department of Medical Sciences, Uppsala University Hospital, entr 40, 75185, Uppsala, Sweden. Email: inga.soveri{at}medsci.uu.se
Background. Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial.
Methods. All patients were on cyclosporine-based immunosuppressive therapy, follow-up was 5–6 years and captured endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke.
Results. A calculated 84 µmol/l increase in serum creatinine was needed to double the risk for cardiac death, an increase of 104 µmol/l to double the risk for non-cardiovascular death and an increase of 92 µmol/l to double the risk for all-cause mortality. MACE risk was doubled if serum creatinine was elevated by 141 µmol/l, age was increased by 23 years, or LDL-cholesterol by 2 mmol/l. Diabetes increased the incidences of cardiac death, all-cause mortality, MACE, stroke and non-fatal MI. A serum creatinine increase of 
130 µmol/l, or 20 years increase in age was calculated as similar in risk for cardiac death, all-cause mortality and MACE, and comparable to risk of diabetes in RTR.
Conclusion. An increase in serum creatinine of 80–100 µmol/l doubles the risk for cardiac death, non-cardiovascular death and all-cause mortality in RTR. An increase of 130 µmol/l in serum creatinine or 20 years increase in age is comparable to risk of diabetes.
Keywords: cardiovascular disease; creatinine; mortality; renal transplantation; risk factors; transplant function
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