Department of Medical Sciences, School of Medicine, University of Ferrara, Italy.
Eur Rev Med Pharmacol Sci. 2017 Oct;21(20):4654-4660.
Kidney transplant recipients (KTRs) are bound to develop cardiovascular disease (CVD), and obesity represents a well-known risk factor for CVD. It has been reported that the metabolic syndrome (MetS) is a frequent finding in KTRs, and MetS could develop even if body mass index (BMI) is only mildly increased. We compared the impact of BMI and MetS on the development of major clinical events (MCEs) in a cohort of 107 KTRs during a follow-up of 63 ± 31 months.
Clinical characteristics were recorded at the time of enrollment and patients were classified on the basis of MCEs development. In a Cox model, MCEs were the dependent variable while age, sex, history of CVD, glomerular filtration rate, length of dialysis pre-transplantation, BMI classes and diagnosis of MetS were independent variables. Patients were classified into 3 groups: normal (BMI < 25 kg/m2), overweight (BMI of 25 to 30 kg/m2) and obese (BMI > 30 kg/m2).
During follow-up, 55 MCEs were recorded: 16 patients died (15%), 19 (18%) had major cardiovascular events (CVEs), and 20 (19%) started dialysis due to graft failure. KTRs who had MCEs (n = 42) were older, had a lower renal function, longer dialysis vintage pre-transplantation, higher prevalence of history of CVD and higher BMI than those without MCEs. Cox regression analysis showed that length of dialysis pre-transplantation, renal function, previous CVD, and BMI classes (overweight and obesity) were related to MCEs.
BMI, but not MetS, predicted MCEs in KTRs as well as non-traditional CVD risk factors such as length of dialysis pre-transplantation and graft function. Thus, a simple evaluation during clinic visits could identify KTRs at high risk for MCEs.
肾移植受者（KTR）必然会发生心血管疾病（CVD），肥胖是 CVD 的一个已知危险因素。据报道，代谢综合征（MetS）在 KTR 中很常见，即使 BMI 仅轻度升高，也可能发生 MetS。我们比较了 BMI 和 MetS 对 107 例 KTR 队列在 63 ± 31 个月随访期间发生主要临床事件（MCEs）的影响。
在入组时记录临床特征，并根据 MCEs 的发生对患者进行分类。在 Cox 模型中，MCEs 是因变量，而年龄、性别、CVD 史、肾小球滤过率、移植前透析时间、BMI 类别和 MetS 诊断是自变量。患者分为 3 组：正常（BMI<25kg/m2）、超重（BMI 为 25 至 30kg/m2）和肥胖（BMI>30kg/m2）。
在随访期间，记录到 55 例 MCEs：16 例患者死亡（15%），19 例（18%）发生重大心血管事件（CVE），20 例（19%）因移植物失功而开始透析。发生 MCEs 的 KTR （n=42）年龄较大，肾功能较低，移植前透析时间较长，CVD 史发生率较高，BMI 较高。Cox 回归分析显示，移植前透析时间、肾功能、既往 CVD 和 BMI 类别（超重和肥胖）与 MCEs 相关。
BMI 但不是 MetS，与非传统 CVD 危险因素如移植前透析时间和移植物功能一起，预测 KTR 的 MCEs。因此，在临床就诊时进行简单评估可以识别出发生 MCEs 风险较高的 KTR。
