Reuter Stefan, Reiermann Stefanie, Malyar Viola, Schütte-Nütgen Katharina, Schmidt Renè, Pavenstädt Hermann, Reinecke Holger, Suwelack Barbara
Department of Internal Medicine D, University Hospital Münster, Münster, Germany.
Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany.
PLoS One. 2016 Oct 21;11(10):e0161927. doi: 10.1371/journal.pone.0161927. eCollection 2016.
Cardiovascular disease (CVD) is the leading cause of death after renal transplantation with a high prevalence in dialysis patients. It is still a matter of debate how to assess the cardiovascular risk in kidney transplant candidates. Several approaches and scores exist and found their way into the guidelines.
We herein assessed PROCAM, Framingham, ESC-SCORE and our own dedicated algorithm in patients applying for renal transplantation at our transplantation center between July 2006 and August 2009. Data of 347 consecutive patients were recorded at baseline and during a follow-up of 4.1 years regarding cardiovascular (CV) events and event-free and overall survival. During follow-up 31 (8.9%) patients died, 24 (6.9%) myocardial infarctions occurred and 19 (5.5%) patients received a new diagnosis of cerebrovascular disease. Predictors for event-free survival identified by univariable Cox regression analysis were age at start of dialysis, ESC-SCORE as well as our own score. Final multivariable model with a stepwise model building procedure revealed age at start of dialysis and smoking to be prognostic for event-free (hazard ratio 1.07/year and 2.15) and overall survival (1.10/year and 3.72).
Comparison of CV risk assessment scores showed that ESC-SCORE most robustly predicted event-free and overall survival in our cohort. We conclude that CV risk assessment by ESC-SCORE can be reasonably performed in kidney transplant candidates.
心血管疾病（CVD）是肾移植后导致死亡的主要原因，在透析患者中患病率很高。如何评估肾移植候选者的心血管风险仍是一个有争议的问题。有几种方法和评分系统，并且已被纳入指南。
我们在此评估了PROCAM、弗雷明汉、ESC评分以及我们自己专门的算法，用于2006年7月至2009年8月期间在我们移植中心申请肾移植的患者。连续347例患者的数据在基线时以及4.1年的随访期间记录了心血管（CV）事件、无事件生存和总生存情况。随访期间，31例（8.9%）患者死亡，24例（6.9%）发生心肌梗死，19例（5.5%）患者被新诊断为脑血管疾病。单变量Cox回归分析确定的无事件生存预测因素为透析开始时的年龄、ESC评分以及我们自己的评分。采用逐步模型构建程序的最终多变量模型显示，透析开始时的年龄和吸烟对无事件生存（风险比分别为每年1.07和2.15）和总生存（分别为每年1.10和3.72）具有预后意义。
心血管风险评估评分的比较表明，ESC评分在我们的队列中最能可靠地预测无事件生存和总生存。我们得出结论，ESC评分可合理用于肾移植候选者的心血管风险评估。
