Ha Joohyung, Jeong Jong Cheol, Ryu Jung-Hwa, Kim Myung-Gyu, Huh Kyu Ha, Lee Kyo Won, Jung Hee-Yeon, Kang Kyung Pyo, Ro Han, Han Seungyeup, Seok Kim Beom, Yang Jaeseok
Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Republic of Korea.
Kidney Dis (Basel). 2024 Apr 16;10(4):249-261. doi: 10.1159/000538929. eCollection 2024 Aug.
Coronary artery calcification score (CACS) and abdominal aortic calcification score (AACS) are both well-established markers of vascular stiffness, and previous studies have shown that a higher CACS is a risk factor for chronic kidney disease (CKD) progression. However, the impact of pretransplant CACS and AACS on cardiovascular and renal outcomes in kidney transplant patients has not been established.
We included 944 kidney transplant recipients from the KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) cohort and categorized them into three groups (low, medium, and high) according to baseline CACS (0, 0 < and ≤100, >100) and AACS (0, 1-4, >4). The low (0), medium (0 < and ≤ 100), and high (>100) CACS groups each consisted of 462, 213, and 225 patients, respectively. Similarly, the low (0), medium (1-4), and high (>4) AACS groups included 638, 159, and 147 patients, respectively. The primary outcome was the occurrence of cardiovascular events. The secondary outcomes were all-cause mortality and composite kidney outcomes, which comprised of >50% decline in the estimated glomerular filtration rate and graft loss. Cox regression analysis was used to investigate the association between baseline CACS/AACS and outcomes.
The high CACS group ( = 462) faced a significantly higher risk for cardiovascular outcomes (adjusted hazard ratio [aHR], 5.97; 95% confidence interval [CI], 2.01-17.7) and all-cause mortality (aHR, 2.74; 95% CI, 1.27-5.92) compared to the low CACS group ( = 225). Similarly, the high AACS group ( = 638) had an elevated risk for cardiovascular outcomes (aHR, 2.38; 95% CI, 1.16-4.88). Furthermore, the addition of CACS to prediction models improved prediction indices for cardiovascular outcomes. However, the risk of renal outcomes did not differ among CACS or AACS groups.
Pretransplant arterial calcification, characterized by high CACS or AACS, is an independent risk factor for cardiovascular outcomes and mortality in kidney transplant patients.
冠状动脉钙化评分（CACS）和腹主动脉钙化评分（AACS）都是公认的血管僵硬度标志物，既往研究表明较高的CACS是慢性肾脏病（CKD）进展的危险因素。然而，肾移植前CACS和AACS对肾移植患者心血管和肾脏结局的影响尚未明确。
我们纳入了来自韩国肾移植患者结局队列研究（KNOW-KT）队列的944例肾移植受者，并根据基线CACS（0、0＜且≤100、＞100）和AACS（0、1 - 4、＞4）将他们分为三组（低、中、高）。低（0）、中（0＜且≤100）、高（＞100）CACS组分别由462例、213例和225例患者组成。同样，低（0）、中（1 - 4）、高（＞4）AACS组分别包括638例、159例和147例患者。主要结局是心血管事件的发生。次要结局是全因死亡率和复合肾脏结局，复合肾脏结局包括估计肾小球滤过率下降＞50%和移植肾丢失。采用Cox回归分析来研究基线CACS/AACS与结局之间的关联。
与低CACS组（n = 225）相比，高CACS组（n = 462）面临心血管结局（调整后风险比[aHR]，5.97；95%置信区间[CI]，2.01 - 17.7）和全因死亡率（aHR，2.74；95%CI，1.27 - 5.92）的显著更高风险。同样，高AACS组（n = 638）发生心血管结局的风险升高（aHR，2.38；95%CI，1.16 - 4.88）。此外，将CACS加入预测模型可改善心血管结局的预测指标。然而，CACS或AACS组之间肾脏结局的风险并无差异。
以高CACS或AACS为特征的肾移植前动脉钙化是肾移植患者心血管结局和死亡的独立危险因素。
