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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 ACS and composite outcomes of ACS and death in divided patients by previous history of vascular disease. a-c. In the patients without a history of vascular disease, ACS (p = 0.567) and composite outcome (p = 0.673) did not show significant difference according to the quartile value of albumin and CRP. b-d. In the patients with a history of vascular disease, ACS (p = 0.002) and composite outcome (p = 0.011) occurred more frequently in the patients in the lowest albumin + highest CRP quartile group than in the other patients
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Fig4: Kaplan-Meier curves of ACS and composite outcomes of ACS and death in divided patients by previous history of vascular disease. a-c. In the patients without a history of vascular disease, ACS (p = 0.567) and composite outcome (p = 0.673) did not show significant difference according to the quartile value of albumin and CRP. b-d. In the patients with a history of vascular disease, ACS (p = 0.002) and composite outcome (p = 0.011) occurred more frequently in the patients in the lowest albumin + highest CRP quartile group than in the other patients

Mentions: To eliminate the strong effect of vascular disease history, we divided the patients by history of vascular disease and evaluated separately. In patients without previous vascular disease, ACS and composite outcome did not show significant difference according to the quartile value of albumin and CRP (Fig. 4a, c). However, in the patients with a history of vascular disease, ACS (p = 0.002, Fig. 4b) and composite outcome (p = 0.011, Fig. 4d) occurred more in the lowest albumin + highest CRP quartile group than in the other groups.Fig. 4


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 ACS and composite outcomes of ACS and death in divided patients by previous history of vascular disease. a-c. In the patients without a history of vascular disease, ACS (p = 0.567) and composite outcome (p = 0.673) did not show significant difference according to the quartile value of albumin and CRP. b-d. In the patients with a history of vascular disease, ACS (p = 0.002) and composite outcome (p = 0.011) occurred more frequently in the patients in the lowest albumin + highest CRP quartile group than in the other patients
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Kaplan-Meier curves of ACS and composite outcomes of ACS and death in divided patients by previous history of vascular disease. a-c. In the patients without a history of vascular disease, ACS (p = 0.567) and composite outcome (p = 0.673) did not show significant difference according to the quartile value of albumin and CRP. b-d. In the patients with a history of vascular disease, ACS (p = 0.002) and composite outcome (p = 0.011) occurred more frequently in the patients in the lowest albumin + highest CRP quartile group than in the other patients
Mentions: To eliminate the strong effect of vascular disease history, we divided the patients by history of vascular disease and evaluated separately. In patients without previous vascular disease, ACS and composite outcome did not show significant difference according to the quartile value of albumin and CRP (Fig. 4a, c). However, in the patients with a history of vascular disease, ACS (p = 0.002, Fig. 4b) and composite outcome (p = 0.011, Fig. 4d) occurred more in the lowest albumin + highest CRP quartile group than in the other groups.Fig. 4

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