Helve Salla, Helanterä Ilkka, Laine Mika, Nieminen Tuomo, Finne Patrik, Helve Jaakko
Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Clin J Am Soc Nephrol. 2024 Mar 1;19(3):355-363. doi: 10.2215/CJN.0000000000000360. Epub 2023 Nov 14.
Cardiovascular diseases are an important cause of mortality in patients who have undergone kidney transplantation, but the knowledge on trends of cardiovascular mortality and specific causes of cardiovascular death among these patients is scarce.
Our aim was to compare the cardiovascular mortality rates after kidney transplantation in Finland between 1990-1999, 2000-2009, and 2010-2019 using data from the Finnish Registry for Kidney Diseases. We analyzed 1-year and long-term cardiovascular mortality rates as well as the specific causes of cardiovascular death and the trends in them.
In total, 4946 patients underwent first kidney transplantation in 1990-2019. During the follow-up time (median 8.3 years, interquartile range 4.0-14.5), there were 1392 deaths, of which 582 were cardiovascular deaths. In an unadjusted Cox regression model, the risk of long-term cardiovascular mortality was similar in the different periods. However, when adjusted for age, sex, duration of dialysis, and cause of kidney disease, the long-term cardiovascular mortality risk was significantly lower in 2000-2009 and 2010-2019 (hazard ratio 0.60 [95% confidence interval, 0.49 to 0.73] and hazard ratio 0.51 [95% confidence interval, 0.39 to 0.66], respectively) compared with 1990-1999. The results were similar regarding 1-year cardiovascular mortality. The distribution of different causes of cardiovascular death remained unchanged during the study period, with coronary artery disease accounting for 47% of deaths. During the first year after transplantation, pulmonary embolisms and arrhythmias were more common than in the long term.
Cardiovascular disease remained the most common cause of death in kidney transplant recipients, but adjusted cardiovascular mortality risk has decreased significantly during the past three decades. Coronary artery disease was the most frequent cause of cardiovascular death, and the proportion of coronary artery disease-related cardiovascular deaths increased after the first year after transplantation.
心血管疾病是肾移植患者死亡的重要原因，但关于这些患者心血管死亡率趋势及心血管死亡具体原因的了解却很少。
我们的目的是利用芬兰肾脏疾病登记处的数据，比较1990 - 1999年、2000 - 2009年和2010 - 2019年芬兰肾移植后的心血管死亡率。我们分析了1年和长期的心血管死亡率以及心血管死亡的具体原因及其趋势。
1990 - 2019年共有4946例患者接受了首次肾移植。在随访期间（中位时间8.3年，四分位间距4.0 - 14.5年），有1392例死亡，其中582例为心血管死亡。在未调整的Cox回归模型中，不同时期长期心血管死亡风险相似。然而，在调整年龄、性别、透析时间和肾脏疾病病因后，2000 - 2009年和2010 - 2019年的长期心血管死亡风险显著低于1990 - 1999年（风险比分别为0.60 [95%置信区间，0.49至0.73]和风险比0.51 [95%置信区间，0.39至0.66]）。1年心血管死亡率的结果相似。在研究期间，心血管死亡的不同原因分布保持不变，冠状动脉疾病占死亡病例的47%。移植后的第一年，肺栓塞和心律失常比长期更常见。
心血管疾病仍然是肾移植受者最常见的死亡原因，但在过去三十年中，调整后的心血管死亡风险显著降低。冠状动脉疾病是心血管死亡最常见的原因，且与冠状动脉疾病相关的心血管死亡比例在移植后第一年之后有所增加。
