Background. Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial.
Methods. All patients were on cyclosporine-based immunosuppressive therapy, follow-up was 5-6 years and captured endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke.
Results. A calculated 84 mu mol/l increase in serum creatinine was needed to double the risk for cardiac death, an increase of 104 mu mol/l to double the risk for non-cardiovascular death and an increase of 92 mu mol/l to double the risk for all-cause mortality. MACE risk was doubled if serum creatinine was elevated by 141 mu mol/l, age was increased by 23 years, or LDL-cholesterol by 2 mmol/l. Diabetes increased the incidences of cardiac death, all-cause mortality, MACE, stroke and non-fatal MI. A serum creatinine increase of similar to 130 mu mol/l, or similar to 20 years increase in age was calculated as similar in risk for cardiac death, all-cause mortality and MACE, and comparable to risk of diabetes in RTR.
Conclusion. An increase in serum creatinine of 80-100 mu mol/l doubles the risk for cardiac death, non-cardiovascular death and all-cause mortality in RTR. An increase of 130 mu mol/l in serum creatinine or similar to 20 years increase in age is comparable to risk of diabetes.
2006. Vol. 21, no 8, 2282-2289 p.
cardiovascular disease, creatinine, mortality, renal transplantation, risk factors, transplant function