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Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation.

Hwang JH, Ryu J, An JN, Kim CT, Kim H, Yang J, Ha J, Chae DW, Ahn C, Jung IM, Oh YK, Lim CS, Han DJ, Park SK, Kim YS, Kim YH, Lee JP - BMC Nephrol (2015)

Bottom Line: The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score.In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea. dennyjinho@gmail.com.

ABSTRACT

Background: Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.

Methods: We enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2-4, 6, 8-10).

Results: The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).

Conclusions: The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves of fatal/non-fatal acute coronary syndrome (ACS) and composite outcomes of ACS and death in patients with different MIA factors. a-b. The patients in the lowest albumin quartile showed worse ACS outcomes (p = 0.042) and composite outcomes of ACS and death (p = 0.016) than the others. c-d. The patients in the highest CRP quartile showed tendency of worse ACS outcomes (p = 0.106) and composite outcomes of ACS and death (p = 0.187) although statistically insignificant. e-f. The patients with previous history of vascular disease showed poor outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than the others
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Fig2: Kaplan-Meier curves of fatal/non-fatal acute coronary syndrome (ACS) and composite outcomes of ACS and death in patients with different MIA factors. a-b. The patients in the lowest albumin quartile showed worse ACS outcomes (p = 0.042) and composite outcomes of ACS and death (p = 0.016) than the others. c-d. The patients in the highest CRP quartile showed tendency of worse ACS outcomes (p = 0.106) and composite outcomes of ACS and death (p = 0.187) although statistically insignificant. e-f. The patients with previous history of vascular disease showed poor outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than the others

Mentions: There was a significant difference in occurrence of ACS (p = 0.042) and composite outcomes (p = 0.016) between the lowest quartile and the others when albumin level was analyzed (Fig. 2a, b). Our findings indicate that increased CRP level was not predictive of ACS (p = 0.106) or composite outcomes (p = 0.187) (Fig. 2c, d). Previous history of vascular disease (any cardiovascular, cerebrovascular, or peripheral vascular disease) was significantly related with ACS (p < 0.001) and composite outcomes (p < 0.001) (Fig. 2e, F). In 1233 patients without a history of vascular disease, 21 patients experienced ACS after transplantation. However, in 115 patients with a history of vascular disease, 12 patients experienced ACS.Fig. 2


Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation.

Hwang JH, Ryu J, An JN, Kim CT, Kim H, Yang J, Ha J, Chae DW, Ahn C, Jung IM, Oh YK, Lim CS, Han DJ, Park SK, Kim YS, Kim YH, Lee JP - BMC Nephrol (2015)

Kaplan-Meier curves of fatal/non-fatal acute coronary syndrome (ACS) and composite outcomes of ACS and death in patients with different MIA factors. a-b. The patients in the lowest albumin quartile showed worse ACS outcomes (p = 0.042) and composite outcomes of ACS and death (p = 0.016) than the others. c-d. The patients in the highest CRP quartile showed tendency of worse ACS outcomes (p = 0.106) and composite outcomes of ACS and death (p = 0.187) although statistically insignificant. e-f. The patients with previous history of vascular disease showed poor outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than the others
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4508766&req=5

Fig2: Kaplan-Meier curves of fatal/non-fatal acute coronary syndrome (ACS) and composite outcomes of ACS and death in patients with different MIA factors. a-b. The patients in the lowest albumin quartile showed worse ACS outcomes (p = 0.042) and composite outcomes of ACS and death (p = 0.016) than the others. c-d. The patients in the highest CRP quartile showed tendency of worse ACS outcomes (p = 0.106) and composite outcomes of ACS and death (p = 0.187) although statistically insignificant. e-f. The patients with previous history of vascular disease showed poor outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than the others
Mentions: There was a significant difference in occurrence of ACS (p = 0.042) and composite outcomes (p = 0.016) between the lowest quartile and the others when albumin level was analyzed (Fig. 2a, b). Our findings indicate that increased CRP level was not predictive of ACS (p = 0.106) or composite outcomes (p = 0.187) (Fig. 2c, d). Previous history of vascular disease (any cardiovascular, cerebrovascular, or peripheral vascular disease) was significantly related with ACS (p < 0.001) and composite outcomes (p < 0.001) (Fig. 2e, F). In 1233 patients without a history of vascular disease, 21 patients experienced ACS after transplantation. However, in 115 patients with a history of vascular disease, 12 patients experienced ACS.Fig. 2

Bottom Line: The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score.In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea. dennyjinho@gmail.com.

ABSTRACT

Background: Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.

Methods: We enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2-4, 6, 8-10).

Results: The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).

Conclusions: The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

No MeSH data available.


Related in: MedlinePlus