Birdwell Kelly Ann, Jaffe Gilad, Bian Aihua, Wu Pingsheng, Ikizler Talat Alp
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue, S-3223 MCN, Nashville, TN, 37232, USA.
University at Buffalo School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY, 14260, USA.
BMC Nephrol. 2015 Jul 2;16:93. doi: 10.1186/s12882-015-0092-7.
The leading cause of death in end stage renal disease is cardiovascular disease (CVD). Kidney transplantation is associated with improved survival over dialysis. We hypothesized that arterial stiffness, a marker of CVD, would improve in patients post kidney transplant, potentially explaining one mechanism of survival benefit from transplant.
After obtaining Institutional Review Board approval and informed consent, we performed a longitudinal prospective cohort study of 66 newly transplanted adult kidney transplant recipients, using aortic pulse wave velocity (PWV) to assess arterial stiffness over a 12 month period. All patients were assessed within one month of transplant (baseline) and 12 months post transplant. The primary outcome was change in PWV score at 12 months which we assessed using Wilcoxon Signed Rank test. Secondary analyses included correlation of predictors with PWV score at both time points.
The median age of the cohort was 49.7 years at transplant, with 27 % Black and 27 % female. At baseline, 43 % had tobacco use, 30 % had a history of CVD, and 42 % had diabetes. Median baseline calcium was 9.1 mg/dL and median phosphorus was 5.1 mg/dL. Median PWV score was 9.25 and 8.97 m/s at baseline versus month 12, respectively, showing no significant change (median change of -0.07, p = 0.7). In multivariable regression, subjects with increased age at transplant (p = 0.008), diabetes (p = 0.002), and a higher baseline PWV score (p < 0.001) were at increased risk of having a high PWV score 12 months post transplant.
Aortic arterial stiffness does not progress in the first year post kidney transplant. Increasing age, diabetes, and higher baseline PWV score identify patients at risk for increased arterial stiffness. Further research that assesses patients for greater than one year and includes a control dialysis group would be helpful in further understanding the change in arterial stiffness post transplantation.
终末期肾病的主要死因是心血管疾病（CVD）。肾移植与透析相比可提高生存率。我们假设，作为心血管疾病标志物的动脉僵硬度在肾移植术后患者中会有所改善，这可能解释了移植带来生存获益的一种机制。
在获得机构审查委员会批准并取得知情同意后，我们对66例新接受移植的成年肾移植受者进行了一项纵向前瞻性队列研究，使用主动脉脉搏波速度（PWV）在12个月内评估动脉僵硬度。所有患者在移植后1个月内（基线）和移植后12个月进行评估。主要结局是12个月时PWV评分的变化，我们使用Wilcoxon符号秩检验进行评估。二次分析包括两个时间点预测因素与PWV评分的相关性。
该队列患者移植时的中位年龄为49.7岁，27%为黑人，27%为女性。基线时，43%的患者吸烟，30%有心血管疾病史，42%患有糖尿病。基线时钙的中位数为9.1mg/dL，磷的中位数为5.1mg/dL。基线时PWV评分中位数分别为9.25和12个月时的8.97m/s，无显著变化（中位数变化为-0.07，p=0.7）。在多变量回归中，移植时年龄增加（p=0.008）、糖尿病（p=0.002）和基线PWV评分较高（p<0.001）的受试者在移植后12个月时PWV评分较高的风险增加。
肾移植术后第一年主动脉僵硬度无进展。年龄增加、糖尿病和较高的基线PWV评分可识别动脉僵硬度增加风险的患者。进一步评估患者超过一年并纳入对照透析组的研究将有助于进一步了解移植后动脉僵硬度的变化。
