Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients

Joshua R. Lewis, Germaine Wong, Anne Taverniti, Mirna Vucak-Dzumhur, Grahame J. Elder

Research output: Contribution to journalArticle

Abstract

Background: Cardiovascular (CV) disease is the leading cause of death in kidney and simultaneous pancreas-kidney (SPK) transplant recipients. Assessing abdominal aortic calcification (AAC), using lateral spine X-rays and the Kaupilla 24-point AAC (0-24) score, may identify transplant recipients at higher CV risk. Methods: Between the years 2000 and 2015, 413 kidney and 213 SPK first transplant recipients were scored for AAC at time of transplant and then followed for CV events (coronary heart, cerebrovascular, or peripheral vascular disease), graft-loss, and all-cause mortality. Results: The mean age was 44 ± 12 years (SD) with 275 (44%) having AAC (26% moderate: 1-7 and 18% high: ≥8). After a median of 65 months (IQR 29-107 months), 46 recipients experienced CV events, 59 died, and 80 suffered graft loss. For each point increase in AAC, the unadjusted hazard ratios (HR) for CV events and mortality were 1.11 (95% CI 1.07-1.15) and 1.11 (1.08-1.15). These were similar after adjusting for age, gender, smoking, transplant type, dialysis vintage, and diabetes: aHR 1.07 (95% CI 1.02-1.12) and 1.09 (1.04-1.13). For recipients with high versus no AAC, the unadjusted and fully-adjusted HRs for CV events were 5.90 (2.90-12.02) and 3.51 (1.54-8.00), for deaths 5.39 (3.00-9.68) and 3.38 (1.71-6.70), and for graft loss 1.30 (0.75-2.28) and 1.94 (1.04-3.27) in age and smoking history-adjusted analyses. Conclusion: Kidney and SPK transplant recipients with high AAC have 3-fold higher CV and mortality risk and poorer graft outcomes than recipients without AAC. AAC scoring may be useful in assessing and targeted risk-lowering strategies.

Original languageEnglish
Pages (from-to)177-186
JournalAmerican Journal of Nephrology
Volume50
Issue number3
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Pancreas
Transplants
Kidney
Mortality
Smoking
Peripheral Vascular Diseases
Transplant Recipients
Dialysis
Cause of Death
Spine
Cardiovascular Diseases
History
X-Rays

Cite this

Lewis, Joshua R. ; Wong, Germaine ; Taverniti, Anne ; Vucak-Dzumhur, Mirna ; Elder, Grahame J. / Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients. In: American Journal of Nephrology. 2019 ; Vol. 50, No. 3. pp. 177-186.
@article{39e6adff7004425ebf1ec4ae8e8544eb,
title = "Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients",
abstract = "Background: Cardiovascular (CV) disease is the leading cause of death in kidney and simultaneous pancreas-kidney (SPK) transplant recipients. Assessing abdominal aortic calcification (AAC), using lateral spine X-rays and the Kaupilla 24-point AAC (0-24) score, may identify transplant recipients at higher CV risk. Methods: Between the years 2000 and 2015, 413 kidney and 213 SPK first transplant recipients were scored for AAC at time of transplant and then followed for CV events (coronary heart, cerebrovascular, or peripheral vascular disease), graft-loss, and all-cause mortality. Results: The mean age was 44 ± 12 years (SD) with 275 (44{\%}) having AAC (26{\%} moderate: 1-7 and 18{\%} high: ≥8). After a median of 65 months (IQR 29-107 months), 46 recipients experienced CV events, 59 died, and 80 suffered graft loss. For each point increase in AAC, the unadjusted hazard ratios (HR) for CV events and mortality were 1.11 (95{\%} CI 1.07-1.15) and 1.11 (1.08-1.15). These were similar after adjusting for age, gender, smoking, transplant type, dialysis vintage, and diabetes: aHR 1.07 (95{\%} CI 1.02-1.12) and 1.09 (1.04-1.13). For recipients with high versus no AAC, the unadjusted and fully-adjusted HRs for CV events were 5.90 (2.90-12.02) and 3.51 (1.54-8.00), for deaths 5.39 (3.00-9.68) and 3.38 (1.71-6.70), and for graft loss 1.30 (0.75-2.28) and 1.94 (1.04-3.27) in age and smoking history-adjusted analyses. Conclusion: Kidney and SPK transplant recipients with high AAC have 3-fold higher CV and mortality risk and poorer graft outcomes than recipients without AAC. AAC scoring may be useful in assessing and targeted risk-lowering strategies.",
keywords = "Cardiovascular disease, Kidney transplant, Mortality, Simultaneous pancreas-kidney transplant, Vascular calcification",
author = "Lewis, {Joshua R.} and Germaine Wong and Anne Taverniti and Mirna Vucak-Dzumhur and Elder, {Grahame J.}",
year = "2019",
month = "9",
doi = "10.1159/000502328",
language = "English",
volume = "50",
pages = "177--186",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S Karger AG",
number = "3",

}

Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients. / Lewis, Joshua R.; Wong, Germaine; Taverniti, Anne; Vucak-Dzumhur, Mirna; Elder, Grahame J.

In: American Journal of Nephrology, Vol. 50, No. 3, 09.2019, p. 177-186.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients

AU - Lewis, Joshua R.

AU - Wong, Germaine

AU - Taverniti, Anne

AU - Vucak-Dzumhur, Mirna

AU - Elder, Grahame J.

PY - 2019/9

Y1 - 2019/9

N2 - Background: Cardiovascular (CV) disease is the leading cause of death in kidney and simultaneous pancreas-kidney (SPK) transplant recipients. Assessing abdominal aortic calcification (AAC), using lateral spine X-rays and the Kaupilla 24-point AAC (0-24) score, may identify transplant recipients at higher CV risk. Methods: Between the years 2000 and 2015, 413 kidney and 213 SPK first transplant recipients were scored for AAC at time of transplant and then followed for CV events (coronary heart, cerebrovascular, or peripheral vascular disease), graft-loss, and all-cause mortality. Results: The mean age was 44 ± 12 years (SD) with 275 (44%) having AAC (26% moderate: 1-7 and 18% high: ≥8). After a median of 65 months (IQR 29-107 months), 46 recipients experienced CV events, 59 died, and 80 suffered graft loss. For each point increase in AAC, the unadjusted hazard ratios (HR) for CV events and mortality were 1.11 (95% CI 1.07-1.15) and 1.11 (1.08-1.15). These were similar after adjusting for age, gender, smoking, transplant type, dialysis vintage, and diabetes: aHR 1.07 (95% CI 1.02-1.12) and 1.09 (1.04-1.13). For recipients with high versus no AAC, the unadjusted and fully-adjusted HRs for CV events were 5.90 (2.90-12.02) and 3.51 (1.54-8.00), for deaths 5.39 (3.00-9.68) and 3.38 (1.71-6.70), and for graft loss 1.30 (0.75-2.28) and 1.94 (1.04-3.27) in age and smoking history-adjusted analyses. Conclusion: Kidney and SPK transplant recipients with high AAC have 3-fold higher CV and mortality risk and poorer graft outcomes than recipients without AAC. AAC scoring may be useful in assessing and targeted risk-lowering strategies.

AB - Background: Cardiovascular (CV) disease is the leading cause of death in kidney and simultaneous pancreas-kidney (SPK) transplant recipients. Assessing abdominal aortic calcification (AAC), using lateral spine X-rays and the Kaupilla 24-point AAC (0-24) score, may identify transplant recipients at higher CV risk. Methods: Between the years 2000 and 2015, 413 kidney and 213 SPK first transplant recipients were scored for AAC at time of transplant and then followed for CV events (coronary heart, cerebrovascular, or peripheral vascular disease), graft-loss, and all-cause mortality. Results: The mean age was 44 ± 12 years (SD) with 275 (44%) having AAC (26% moderate: 1-7 and 18% high: ≥8). After a median of 65 months (IQR 29-107 months), 46 recipients experienced CV events, 59 died, and 80 suffered graft loss. For each point increase in AAC, the unadjusted hazard ratios (HR) for CV events and mortality were 1.11 (95% CI 1.07-1.15) and 1.11 (1.08-1.15). These were similar after adjusting for age, gender, smoking, transplant type, dialysis vintage, and diabetes: aHR 1.07 (95% CI 1.02-1.12) and 1.09 (1.04-1.13). For recipients with high versus no AAC, the unadjusted and fully-adjusted HRs for CV events were 5.90 (2.90-12.02) and 3.51 (1.54-8.00), for deaths 5.39 (3.00-9.68) and 3.38 (1.71-6.70), and for graft loss 1.30 (0.75-2.28) and 1.94 (1.04-3.27) in age and smoking history-adjusted analyses. Conclusion: Kidney and SPK transplant recipients with high AAC have 3-fold higher CV and mortality risk and poorer graft outcomes than recipients without AAC. AAC scoring may be useful in assessing and targeted risk-lowering strategies.

KW - Cardiovascular disease

KW - Kidney transplant

KW - Mortality

KW - Simultaneous pancreas-kidney transplant

KW - Vascular calcification

UR - http://www.scopus.com/inward/record.url?scp=85070762308&partnerID=8YFLogxK

U2 - 10.1159/000502328

DO - 10.1159/000502328

M3 - Article

VL - 50

SP - 177

EP - 186

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

IS - 3

ER -