Department of Radiology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India.
Department of Nephrology, Medical Division, Command Hospital Air Force, Bangalore, Karnataka, India.
Saudi J Kidney Dis Transpl. 2023 Sep 1;34(5):378-388. doi: 10.4103/1319-2442.397199. Epub 2024 Mar 11.
Arterial stiffness is a non-traditional risk factor of cardiovascular disease and may explain part of the excess cardiovascular risk in chronic kidney disease patients. Successful renal transplantation (RT) may restore renal function and improve several metabolic abnormalities involved in arterial stiffness. This prospective study conducted non-invasive assessments of arterial stiffness indices [the augmentation index (AI) and pulse wave velocity (PWV)] in end-stage kidney disease (ESKD) patients before RT and 3 and 6 months after living-donor RT, alongside the effects of age and calcineurin inhibitors on arterial stiffness. The study included 26 ESKD patients (22 males and 4 females; mean age, 34.07 years; median duration of dialysis, 10 months) scheduled for RT and followed up for three visits (within 1 week before transplantation, and 3 and 6 months after transplantation). Six months after successful RT, the patients had nearly normal serum creatinine and significantly improved serum phosphate and intact parathyroid hormone levels. The pretransplant AI was 21.53% ± 13.61% which reduced significantly 6 months after RT to 16.19% ± 10.74% (P <0.05). Although there was a reduction in PWV 6 months after RT from the pre-transplant PWV, it was not significant. A significant correlation between age and the augmentation index was noted 3 and 6 months after RT. Patients on tacrolimus-based immunosuppression after RT showed significant improvements in the AI compared with patients on a cyclosporine-based regimen. RT helped to improve arterial stiffness indices, resulting in reduced cardiovascular risk.
动脉僵硬度是心血管疾病的一种非传统危险因素，它可能部分解释了慢性肾脏病患者心血管风险增加的原因。成功的肾移植（RT）可以恢复肾功能，并改善与动脉僵硬度相关的多种代谢异常。本前瞻性研究对终末期肾病（ESKD）患者在 RT 前以及活体供肾 RT 后 3 个月和 6 个月时进行了非侵入性动脉僵硬度指标评估[增强指数（AI）和脉搏波速度（PWV）]，同时还评估了年龄和钙调神经磷酸酶抑制剂对动脉僵硬度的影响。该研究纳入了 26 名 ESKD 患者（22 名男性和 4 名女性；平均年龄 34.07 岁；中位透析时间 10 个月），他们计划进行 RT，并进行了 3 次随访（在移植前 1 周内、移植后 3 个月和 6 个月时）。成功 RT 后 6 个月，患者的血清肌酐接近正常，血清磷酸盐和全段甲状旁腺激素水平显著改善。移植前 AI 为 21.53%±13.61%，RT 后 6 个月显著降低至 16.19%±10.74%（P<0.05）。尽管 RT 后 6 个月 PWV 有所下降，但无统计学意义。RT 后 3 个月和 6 个月时，年龄与增强指数之间存在显著相关性。与环孢素为基础的免疫抑制方案相比，接受他克莫司为基础免疫抑制方案的患者在 RT 后 AI 显著改善。RT 有助于改善动脉僵硬度指标，从而降低心血管风险。
