Czyzewski Lukasz, Wyzgal Janusz, Czyzewska Emilia, Kurowski Andrzej, Sierdzinski Janusz, Truszewski Zenon, Szarpak Lukasz
From the Department of Nephrology Nursing (LC, JW); Department of Laboratory Medicine, Medical University of Warsaw (EC); Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology (AK); Division of Medical Informatics and Telemedicine (JS); and Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland (ZT, LS).
Medicine (Baltimore). 2016 Feb;95(6):e2819. doi: 10.1097/MD.0000000000002819.
Reduction of cardiovascular death might have a significant effect on the long-term survival rates of renal transplant recipients (RTRs). The aim of the study was to assess the relation between arterial stiffness and graft function, adipose tissue content, and hydration status in patients after kidney transplantation (KTx).The study included 83 RTR patients (mean age: 55 ± 13 years) who had been admitted to a nephrology-transplantation outpatient clinic 0.5 to 24 years after KTx. Clinical and laboratory data were analyzed and eGFR was calculated with the CKD-EPI formula. Arterial stiffness was assessed in all RTRs with pulse wave propagation velocity (PWV) with the use of a complior device. In addition, fluid and nutritional status was assessed with a Tanita BC 418 body composition analyzer. The control group consisted of 31 hospital workers who received no medication and had no history of cardiovascular disease.Multivariable linear regression analysis, with PWV as a dependent variable, retained the following independent predictors in the final regression model: red blood cell distribution width (RDW) (B = 0.323; P = 0.004), age (B = 0.297; P = 0.005), tacrolimus therapy (B = -0.286; P = 0.004), and central DBP (B = 0.185; P = 0.041). Multivariable linear regression analysis with eGFR as a dependent variable retained the following independent predictors in the final regression model; creatinine concentration (B = -0.632; P = 0.000), hemoglobin (B = 0.280; P = 0.000), CRP (B = -0.172; P = 0.011), tacrolimus therapy (B = 0.142; P = 0.039), and triglycerides (B = -0.142; P = 0.035).Our data indicates that: kidney transplant recipients can present modifiable CVD risk factors linked to increased arterial stiffness, DBP, waist circumference, SCr, time on dialysis, CyA therapy, and visceral fat mass; RDW is a parameter associated with arterial stiffness; and parameters such as CyA therapy, time on dialysis, PWV, RDW, and triglycerides show negative associations with the allograft function assessed with eGFR.
降低心血管死亡可能对肾移植受者(RTR)的长期生存率产生重大影响。本研究的目的是评估肾移植(KTx)术后患者动脉僵硬度与移植肾功能、脂肪组织含量和水合状态之间的关系。
该研究纳入了83例RTR患者(平均年龄:55±13岁),这些患者在KTx术后0.5至24年入住肾脏病移植门诊。分析临床和实验室数据,并使用CKD-EPI公式计算估算肾小球滤过率(eGFR)。使用Complior设备通过脉搏波传播速度(PWV)评估所有RTR患者的动脉僵硬度。此外,使用Tanita BC 418人体成分分析仪评估液体和营养状况。对照组由31名未服用药物且无心血管疾病史的医院工作人员组成。
以PWV为因变量的多变量线性回归分析在最终回归模型中保留了以下独立预测因素:红细胞分布宽度(RDW)(B = 0.323;P = 0.004)、年龄(B = 0.297;P = 0.005)、他克莫司治疗(B = -0.286;P = 0.004)和中心舒张压(DBP)(B = 0.185;P = 0.041)。以eGFR为因变量的多变量线性回归分析在最终回归模型中保留了以下独立预测因素;肌酐浓度(B = -0.632;P = 0.000)、血红蛋白(B = 0.280;P = 0.000)、C反应蛋白(CRP)(B = -0.172;P = 0.011)、他克莫司治疗(B = 0.142;P = 0.039)和甘油三酯(B = -0.142;P = 0.035)。
肾移植受者可能存在与动脉僵硬度增加、舒张压、腰围、血清肌酐、透析时间、环孢素A(CyA)治疗和内脏脂肪量相关的可改变的心血管疾病(CVD)危险因素;RDW是与动脉僵硬度相关的参数;并且诸如CyA治疗、透析时间、PWV、RDW和甘油三酯等参数与用eGFR评估的同种异体移植功能呈负相关。