Even with protocols in place to improve compliance, many kidney transplant patients did not achieve risk factor targets for cardiovascular disease, a leading cause of graft failure and of death after transplantation, according to study results presented at the American Transplant Congress in Philadelphia in early May. But as time went on after transplantation, the modifiable risk factors of hypertension, hyperlipidemia, and diabetes mellitus could become better controlled, said lead author Rakesh Kumar, MD, of the State University of New York at Buffalo.
Although advances in immunosuppressive therapy can prevent immune-mediated damage to transplanted kidneys and improve short-term allograft survival, the same factors that increase cardiovascular risk—hypertension, dyslipidemia, and diabetes—also affect the function and survival of grafts. Cardiovascular disease in itself accounts for up to 25 percent of patient deaths in the long term.
In this single-center retrospective chart review study performed at the university-affiliated Erie County Medical Center Kidney-Pancreas Transplant Unit, the researchers assessed blood pressure and levels of LDL cholesterol and hemoglobin A1c (HbA1c) annually, starting 1 year after transplant. Data were collected for 1–5 years (2005–2009) depending on the date of the transplant.
Uncontrolled blood pressure was defined as readings above 130/80 mm Hg on three or more occasions over 5 years. The results were compared with the Kidney Disease: Improving Global Outcomes (KDIGO) recommended guidelines of blood pressure no greater than 130/80 mm Hg, LDL cholesterol less than or equal to 100 mg/dL, and HbA1c less than or equal to 7.5 percent. The immunosuppressive regimen was alemtuzumab induction with tacrolimus and mycophenolate maintenance.
The 128 patients (44 women) in the study had a mean age of 51 years; 6 percent were white, 44 percent had a history of diabetes, 83 percent had dyslipidemia at the time of the study, and 96 percent were hypertensive. Thirty-four percent were taking three or more antihypertensive medications.