期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 59, 期 2, 页码 258-269出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2011.07.019
关键词
Renal transplantation; vascular calcification; clinical determinants; cardiovascular disease
资金
- Fonds National de la Recherche Scientifique Medicale
- Fondation Saint-Luc
- EU [LSHM CT 2006 037697]
- Fondation Alphonse & Jean Forton, an Interuniversity Attraction Pole [IUAP P6/05]
- Communaute Francaise de Belgique
Background: Vascular calcification independently predicts cardiovascular disease, the major cause of death in kidney transplant recipients (KTRs). Longitudinal studies of vascular calcification in KTRs are few and small and have short follow-up. We assessed the evolution of coronary artery (CAC) and thoracic aorta calcification and their determinants in a cohort of prevalent KTRs. Study Design: Longitudinal. Setting & Participants: The Agatston score of coronary arteries and thoracic aorta was measured by 16-slice spiral computed tomography in 281 KTRs. Predictors: Demographic, clinical, and biochemical parameters were recorded simultaneously. Outcomes & Measurements: The Agatston score was measured again 3.5 or more years later. Results: Repeated analyzable computed tomographic scans were available for 197 (70%) KTRs after 4.40 +/- 0.28 years; they were not available for the rest of patients because of death (n = 40), atrial fibrillation (n = 1), other arrhythmias (n = 4), refusal (n = 35), or technical problems precluding confident calcium scoring (n = 4). CAC and aorta calcification scores increased significantly (by a median of 11% and 4% per year, respectively) during follow-up. By multivariable linear regression, higher baseline CAC score, history of cardiovascular event, use of a statin, and lower 25-hydroxyvitamin D-3 level were independent determinants of CAC progression. Independent determinants of aorta calcification progression were higher baseline aorta calcification score, higher pulse pressure, use of a statin, older age, higher serum phosphate level, use of aspirin, and male sex. Significant regression of CAC or aorta calcification was not observed in this cohort. Limitations: Cohort of prevalent KTRs with potential survival bias; few patients with diabetes and non-whites, limiting the generalizability of results. Conclusion: In contrast to previous small short-term studies, we show that vascular calcification progression is substantial within 4 years in prevalent KTRs and is associated with several traditional and nontraditional cardiovascular risk factors, some of which are modifiable. Am J Kidney Dis. 59(2): 258-269. (C) 2012 by the National Kidney Foundation, Inc.
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