Post-transplantation Anemia Predicts Cardiovascular Morbidity and Poor Graft Function in Kidney Transplant Recipients.

OBJECTIVE: We aimed to investigate whether low post-transplantation-period hemoglobin levels are predictive of cardiovascular morbidity in terms of left ventricular (LV) hypertrophy and vascular stiffness and to determine the contributing factors of post-transplantation anemia in kidney transplant (KT) recipients. METHODS: One hundred fifty (mean age, 38.9 ± 10.8 y; 113 male) KT recipients with functioning grafts were enrolled in the study. All subjects underwent clinical and laboratory evaluations (24-hour urinary protein loss, complete blood count) and transthoracic echocardiography to assess LV systolic function. Arterial stiffness was measured by means of carotid-femoral pulse-wave velocity (PWV). Mean hemoglobin levels were analyzed at the 1st, 6th, 12th, and 24th months after transplantation. Patients were divided into 2 groups according to presence of anemia: patients with anemia (group 1; n = 120) and normal (group 2; n = 30). RESULTS: PWV values (6.8 ± 1.9 m/s vs 6.4 ± 1.1 m/s in groups 1 and 2, respectively; P = .002) and LV mass index (LVMI; 252.1 ± 93.7 g/m(2) vs 161.2 ± 38.5 g/m(2) groups 1 and 2, respectively; P = .001) were significantly higher in group 1. Estimated glomerular filtration rate and (64 ± 28.5 m/min vs 77.8 ± 30 m/min in groups 1 and 2, respectively; P = .001) LV systolic function (57.2 ± 5.8% vs 77.8 ± 30% in groups 1 and 2, respectively; P < .005) were significantly lower in group 1. In regression analysis, LV systolic function and LVMI were predictors of post-transplantation hemoglobin levels. CONCLUSIONS: Post-transplantation anemia contributes to cardiovascular morbidity by deteriorating LV function and increasing PWV and is therefore associated with poor prognosis for graft survival. Early correction of post-transplantation anemia, especially with the use of erythropoietin, may be beneficial for both graft and recipient survivals.

Graft function and arterial stiffness: can bioimpedance analysis be useful in renal transplant recipients?

OBJECTIVE: We aimed to determine the total body water (TBW) by means of bioimpedance analysis (BIA) and to analyze the association of TBW, graft function, and arterial stiffness by means of pulse-wave velocity (PWV) and echocardiographic measurements in renal transplant (RT) recipients. METHODS: Eighty-two RT recipients (mean age, 38.7 ± 11.5 y; 58 male) who were using ≥1 antihypertensive treatment were enrolled in the study. Biochemical parameters, 24-hour urinary protein loss, estimated glomerular filtration rate (eGFR), transthoracic echocardiography, bioimpedance analysis according to systolic blood pressure, TBW, lean tissue index (LTI), extracellular water (ECW), intracellular water (ICW), lean tissue mass (LTM), phase angle (Phi50) levels, and renal resistive index (RRI) were evaluated. RESULTS: TBW and ECW were significantly correlated with systolic blood pressure. Urinary protein loss, pulmonary artery pressure, frequency of overhydration, systolic blood pressure, TBW, LTI, ECW, ICW, LTM, and Phi50 values were significantly higher in patients with estimated glomerular filtration rate (eGFR) 15-49 mL/min but similar in patients with eGFR 50-70 mL/min. CONCLUSIONS: Hypertensive RT recipients have increased TBW, LTI, ICW, FTI, LTM, and Phi50 values. Graft function is positively correlated with systolic blood pressure and BIA parameters. Therefore, hypertensive RT recipients should be closely followed with the use of BIA for an early diagnosis of loss of graft function.

Dialysis as a bridge therapy to renal transplantation: comparison of graft outcomes according to mode of dialysis treatment.

BACKGROUND: Renal transplantation is the ideal renal replacement therapy in patients with end-stage renal disease. It was unclear whether a difference in dialysis modality influences outcomes after kidney transplantation. Therefore, we evaluated the influence of dialysis modality. METHODS: We compared various clinical and laboratory parameters of 70 peritoneal dialysis (PD) and 180 hemodialysis (HD) patients (n=250), including 91 females and an overall age 36.7±9.7 years who underwent transplantation between 2000 and 2008 to evaluate factors affecting delayed graft function (DGF) and of transplant graft failure. RESULTS: Overall graft survival was 82% at 3 and 75% at 5 years. Among HD patients, 16% displayed DGF, versus 12% of PD patients. Multivariate analysis showed that factors affecting DGF were: mode of dialysis (relative risk [RR]=1.39, 95% confidence interval (CI): 1.35-1.43; P<.01); parathyroid hormone (RR=0.32, 95% CI: 0.30-0.34, P<.05), C-reative protein (RR=1.03, 95% CI: 0.97-1.09; P<.05), hemoglobin levels (RR=.75, 95% CI: 0.72-0.79; P<.05). At 3 and 5 years follow-up, PD patients' showed fewer graft failures than HD patients (14% vs 20%; P<.05 and 17% vs 28%; P<.05). CONCLUSION: Early graft function rates were better for PD than for HD patients. Inflammation and anemia should be carefully investigated and corrected to achieve better graft function.

Circulating levels of osteopontin are related with calcification parameters in patients with renal transplantations.

BACKGROUND: Although osteopontin (OPN) is a local inhibitor of calcification, it may also be an indirect marker of ongoing systemic calcification. There are few data about clinical and laboratory parameters associated with serum OPN levels in renal transplant (RT) patients. We investigated the relationship between insulin resistance and calcification parameters as estimated with OPN after RT. METHODS: Between 1996 and 2006, the study enrolled 81 patients undergoing RT including 26 females and 55 males of overall mean age of 38±10 years. We evaluated demographic features, medications, smoking history, blood pressure values daily proteinuria as well as laboratory values of calcium-phosphate product (Ca×P), body mass index (BMI) and serum OPN. According to OPN values, we stratified patients as: group 1: OPN<8; group 2: OPN 8 to 45 and group 3: OPN≥45. RESULTS: Serum OPN correlated with first month phosphorus (r=0.33, P=.00), Ca×product (r=0.41, P=.02), and proteinuria (r=0.34, P=.00) with negative relations to serum insulin (r=0.28, P=.04). Serum calcium, Ca×product, low-density lipoprotein cholesterol, alkaline phosphatase, Creactive protein and vitamin D values were significantly higher among group 3. Regression analysis showed only Ca×product to be an independent variable affecting serum OPN levels (ß=0.68, P<.01). CONCLUSION: OPN has been implicated in numerous physiological and pathological events including calcification, inflammation, and insulin resistance. Serum OPN may be a marker for increased cardiovascular risk in RT patients.