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A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal transplantation.
Clin J Am Soc Nephrol. 2015 Mar 06; 10(3):471-9.CJ

Abstract

BACKGROUND AND OBJECTIVES

The role of reversibility of nontraditional risk factors, like inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

The longitudinal relationship between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32±10 years) with stage 5 CKD maintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation.

RESULTS

Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis (average=0.9±0.2 mm) was higher (P<0.001) than in well matched healthy controls (0.6±0.1 mm) and reduced substantially (-22%; 95% confidence interval, -24% to -20%) after transplantation (P=0.001). GFR (multivariable-adjusted β=0.23; P<0.001), C-reactive protein (β=0.15; P<0.001), and fibroblast growth factor 23 (β=0.28; P<0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent correlates of simultaneous changes in intima media thickness (C-reactive protein: β=0.25; fibroblast growth factor 23: β=0.26; P<0.001 for both) after renal transplantation. The evolution of intima media thickness after transplantation was largely independent of classic risk factors, including BP, LDL cholesterol, and insulin resistance, as measured by homeostatic model assessment.

CONCLUSIONS

Intima media thickness improves after renal transplantation. Such an improvement associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation, in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and CKD-mineral bone disorder.

Authors+Show Affiliations

Departments of Nephrology, mahmutiyilmaz@yahoo.com.Endocrinology.Radiology.Biochemistry, and.Epidemiology, Gulhane School of Medicine, Etlik-Ankara, Turkey; and.Departments of Nephrology.Departments of Nephrology.Departments of Nephrology.Departments of Nephrology.Departments of Nephrology.Departments of Nephrology.Departments of Nephrology.Nephrology, Hypertension and Renal Transplantation and National Research Council-Institute of Clinical Physiology Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.National Research Council-Institute of Clinical Physiology Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25542907

Citation

Yilmaz, Mahmut Ilker, et al. "A Longitudinal Study of Inflammation, CKD-mineral Bone Disorder, and Carotid Atherosclerosis After Renal Transplantation." Clinical Journal of the American Society of Nephrology : CJASN, vol. 10, no. 3, 2015, pp. 471-9.
Yilmaz MI, Sonmez A, Saglam M, et al. A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal transplantation. Clin J Am Soc Nephrol. 2015;10(3):471-9.
Yilmaz, M. I., Sonmez, A., Saglam, M., Cayci, T., Kilic, S., Unal, H. U., Karaman, M., Cetinkaya, H., Eyileten, T., Gok, M., Oguz, Y., Vural, A., Mallamaci, F., & Zoccali, C. (2015). A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal transplantation. Clinical Journal of the American Society of Nephrology : CJASN, 10(3), 471-9. https://doi.org/10.2215/CJN.07860814
Yilmaz MI, et al. A Longitudinal Study of Inflammation, CKD-mineral Bone Disorder, and Carotid Atherosclerosis After Renal Transplantation. Clin J Am Soc Nephrol. 2015 Mar 6;10(3):471-9. PubMed PMID: 25542907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal transplantation. AU - Yilmaz,Mahmut Ilker, AU - Sonmez,Alper, AU - Saglam,Mutlu, AU - Cayci,Tuncer, AU - Kilic,Selim, AU - Unal,Hilmi Umut, AU - Karaman,Murat, AU - Cetinkaya,Hakki, AU - Eyileten,Tayfun, AU - Gok,Mahmut, AU - Oguz,Yusuf, AU - Vural,Abdulgaffar, AU - Mallamaci,Francesca, AU - Zoccali,Carmine, Y1 - 2014/12/26/ PY - 2014/12/28/entrez PY - 2014/12/30/pubmed PY - 2016/2/3/medline KW - arteriosclerosis KW - chronic inflammation KW - renal transplantation SP - 471 EP - 9 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 10 IS - 3 N2 - BACKGROUND AND OBJECTIVES: The role of reversibility of nontraditional risk factors, like inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The longitudinal relationship between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32±10 years) with stage 5 CKD maintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation. RESULTS: Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis (average=0.9±0.2 mm) was higher (P<0.001) than in well matched healthy controls (0.6±0.1 mm) and reduced substantially (-22%; 95% confidence interval, -24% to -20%) after transplantation (P=0.001). GFR (multivariable-adjusted β=0.23; P<0.001), C-reactive protein (β=0.15; P<0.001), and fibroblast growth factor 23 (β=0.28; P<0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent correlates of simultaneous changes in intima media thickness (C-reactive protein: β=0.25; fibroblast growth factor 23: β=0.26; P<0.001 for both) after renal transplantation. The evolution of intima media thickness after transplantation was largely independent of classic risk factors, including BP, LDL cholesterol, and insulin resistance, as measured by homeostatic model assessment. CONCLUSIONS: Intima media thickness improves after renal transplantation. Such an improvement associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation, in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and CKD-mineral bone disorder. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/25542907/A_longitudinal_study_of_inflammation_CKD_mineral_bone_disorder_and_carotid_atherosclerosis_after_renal_transplantation_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=25542907 DB - PRIME DP - Unbound Medicine ER -