Ningyan Wong, Chee Tang Chin, Ping Sing Tee, Lay Wai Khin, Koh Angela S, Shern Kee Yi, Chieh Tan Wei
Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore.
Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore.
ASEAN Heart J. 2015;23(1):1. doi: 10.7603/s40602-015-0001-0.
For suitable end-stage renal failure (ESRF) patients, renal transplantation gives better long term survival and quality of life as compared to dialysis. Prior to entry into the renal transplant wait list, potential candidates are screened for the presence of cardiovascular disease. However, the waiting time on the transplant list is long, and interval screening for cardiac fitness for surgery is not well defined. We aim to study the risk factors for the development of a cardiovascular event (CVE) and the time interval from recruitment to onset of a CVE that resulted in their removal from the transplant wait list.
A retrospective study of all patients registered under the cadaveric renal transplant waiting list in Singapore General Hospital (SGH) from 16 April 1987 to 31 October 2010. We identified patients who developed a CVE among this cohort. We compared the demographics and clinical characteristics of patients who experienced a CVE versus those who did not. Univariable and multivariable cox regression were performed to investigate the significant variables for the development of a CVE. The time to development of CVE was estimated using Kaplan Meier estimation and log-rank test was used to compare the time to CVE between those with diabetes mellitus and those without.
1265 patients were enrolled in this study. 273 patients dropped out of the wait list due to medical reasons or death, of which 38.8% were due to CVE. The mean and median time duration from recruitment into the waiting list to development of a CVE was 14.42 (95% CI 13.72 to 15.11) and 15.69 (95% CI 13.86 to 17.51) years respectively. For patients with diabetes mellitus, this was 8.22 (95% CI 6.30 to 10.14) and 8.16 (95% CI 4.95 to 11.36) years respectively. Factors associated with an increased risk of developing a CVE included male gender (adjusted HR 2.21, 95% CI 1.43 to 3.41, p<0.001), presence of diabetes mellitus (adjusted HR 5.13, 95% CI 2.85 to 9.24, p<0.001) and patients who were either not working or working part-time as compared to their full-time counterparts (adjusted HR 1.76, 95% CI 1.14 to 2.72, p=0.010). In addition, hazard ratio for CVE significantly increased with advancing age quartile (p<0.001 by log rank test for trend).
A significant proportion of patients exited from the renal transplant wait list due to a CVE. Being male, age 37 years old or more, presence of diabetes mellitus and non-working or part-time workers as compared to full-time workers were found to increase the risk of developing a CVE during the wait period for transplantation. The presence of diabetes mellitus significantly shortened the time to development of a CVE.
对于合适的终末期肾衰竭（ESRF）患者，与透析相比，肾移植能带来更好的长期生存率和生活质量。在进入肾移植等待名单之前，会对潜在候选者进行心血管疾病筛查。然而，移植名单上的等待时间很长，且对于手术心脏适应性的间隔筛查尚无明确规定。我们旨在研究心血管事件（CVE）发生的危险因素以及从招募到导致其被移出移植等待名单的CVE发作的时间间隔。
对1987年4月16日至2010年10月31日在新加坡总医院（SGH）尸体肾移植等待名单上登记的所有患者进行回顾性研究。我们在该队列中确定发生CVE的患者。比较发生CVE的患者与未发生CVE的患者的人口统计学和临床特征。进行单变量和多变量cox回归以研究CVE发生的显著变量。使用Kaplan Meier估计法估计CVE发生的时间，并使用对数秩检验比较糖尿病患者和非糖尿病患者发生CVE的时间。
本研究共纳入1265例患者。273例患者因医疗原因或死亡退出等待名单，其中38.8%是由于CVE。从进入等待名单到发生CVE的平均和中位时间分别为14.42年（95%可信区间13.72至15.11年）和15.69年（95%可信区间13.86至17.51年）。对于糖尿病患者，这分别为8.22年（95%可信区间6.30至10.14年）和8.16年（95%可信区间4.95至11.36年）。与发生CVE风险增加相关的因素包括男性（调整后风险比2.21，95%可信区间1.43至3.41，p<0.001）、糖尿病的存在（调整后风险比5.13，95%可信区间2.85至9.24，p<0.001）以及与全职工作者相比未工作或兼职工作的患者（调整后风险比1.76，95%可信区间1.14至2.72，p=0.010）。此外，CVE的风险比随年龄四分位数的增加而显著增加（趋势对数秩检验p<0.001）。
相当一部分患者因CVE而退出肾移植等待名单。发现男性、37岁及以上、患有糖尿病以及与全职工作者相比未工作或兼职工作会增加移植等待期间发生CVE的风险。糖尿病的存在显著缩短了CVE发生的时间。
