NDT Advance Access originally published online on January 22, 2009
Nephrology Dialysis Transplantation 2009 24(4):1314-1319; doi:10.1093/ndt/gfn753
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Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation
1 Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107 2 Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania 3 Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania 4 Philadelphia Veterans Administration Medical Center, Philadelphia, PA 19104, USA
Correspondence and offprint requests to: Sylvia E. Rosas, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, 1 Founders, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1-215-662-7934; Fax: +1-215-615-0349; E-mail: sylvia.rosas{at}uphs.upenn.edu
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Abstract |
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Background. Cardiovascular disease is a leading cause of death among renal transplant recipients. Aortic calcification is associated with increased mortality in dialysis subjects. The significance of aortic calcification among renal transplant recipients is unknown. Our objective was to prospectively examine the association of aortic calcification with cardiovascular events and all-cause mortality among asymptomatic incident renal transplant recipients.
Methods. One hundred and twelve renal transplant recipients underwent electron beam computed tomography. Aortic calcification was scored by the Agatston method. The mean follow-up time was 5.1 years. Cardiovascular events (heart failure, coronary artery disease, peripheral arterial disease and stroke) and all-cause mortality were recorded.
Results. The cohort consisted of 62% Caucasians, 38% African Americans and 62% male gender. The mean age was 49.0 ± 12.5 years. Thirty-four percent had aortic calcification. During follow-up, 12 cardiovascular events and 10 deaths were recorded. Subjects with aortic calcification had more cardiovascular events compared to those without aortic calcification (23.7 versus 4.1%, P = 0.001). Recipients with aortic calcification had higher mortality compared to those without aortic calcification but it did not reach statistical significance (15.8 versus 5.4%, P = 0.07). The univariate hazard ratio of aortic calcification score in a proportional hazard Cox model to assess event-free survival was 1.15 (1.04–1.27, P = 0.01). Diabetes and aortic calcification score were independently associated with survival. In addition to the predictors above, dialysis vintage was an independent predictor for combined future cardiovascular event and mortality.
Conclusions. In conclusion, aortic calcification is prevalent among renal transplant recipients and is predictive of future cardiovascular events. Aortic calcification is easily identified by non-invasive testing, and should be considered when assessing cardiovascular risk in asymptomatic renal transplant recipients.
Keywords: cardiovascular events; renal transplantation; vascular calcification
Received for publication: 29. 8.08
Accepted in revised form: 15.12.08