Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel,
Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel,
Kidney Blood Press Res. 2019;44(5):1149-1157. doi: 10.1159/000502523. Epub 2019 Sep 19.
Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at an increased risk of cardiovascular (CV) disease. The association between AKI and MACE in kidney transplant patients is yet to be studied.
This retrospective single-center cohort study reviewed 416 adult renal allograft recipients transplanted between 2005 and 2010. AKI events were recorded starting 2 weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria. The primary outcome was the composite of MACE starting 6 months after transplantation and all-cause mortality. For survival analysis, we used univariate and multivariate time varying Cox proportional hazard model.
One hundred and twenty-four patients (29.8%) had at least one episode of AKI. During the median follow-up time of 7.2 years (interquartile range 4.3-9.1), 144 outcome events occurred. By time varying Cox regression analysis, AKI was associated with an increased rate of CV outcomes or death (hazard ratio [HR] 1.96, 95% CI 1.36-2.81, p < 0.001), and the association remained significant by multivariate adjusted model (HR 1.76, 95% CI 1.18-2.63, p = 0.005). As for the different components of MACE, all-cause mortality and CV mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found.
AKI in kidney transplant recipient is associated with an increased risk of CV disease.
急性肾损伤（AKI）在普通人群中与主要不良心血管事件（MACE）的风险增加相关。接受肾移植的患者容易发生 AKI 事件，并且患心血管（CV）疾病的风险也增加。AKI 与肾移植患者的 MACE 之间的关系尚未得到研究。
这是一项回顾性单中心队列研究，共纳入了 2005 年至 2010 年间接受肾移植的 416 名成年肾移植受者。自移植后 2 周或功能移植物出院后开始记录 AKI 事件。根据 KDIGO 标准定义 AKI。主要结局是移植后 6 个月开始的 MACE 复合事件和全因死亡率。对于生存分析，我们使用单变量和多变量时变 Cox 比例风险模型。
124 名患者（29.8%）至少发生过一次 AKI。在中位数为 7.2 年（四分位距 4.3-9.1）的随访期间，发生了 144 例结局事件。通过时变 Cox 回归分析，AKI 与 CV 结局或死亡的发生率增加相关（风险比 [HR] 1.96，95%CI 1.36-2.81，p<0.001），并且在多变量调整模型中仍然具有显著相关性（HR 1.76，95%CI 1.18-2.63，p=0.005）。对于 MACE 的不同组成部分，全因死亡率和 CV 死亡率是与 AKI 显著相关的唯一结局。未发现 AKI 时间与 MACE 之间存在交互作用。
肾移植受者的 AKI 与 CV 疾病风险增加相关。
