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BMC Nephrol. 2015;16:109.

Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation.

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제1저자 황진호 · 교신저자 이정표

PMID 26194096 PMC4508766 DOI 10.1186/s12882-015-0108-3 IF 2.9 신장내과
소속 (18)
  1. Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea. dennyjinho@gmail.com.
  2. Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea. bboddo5@hanmail.net.
  3. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. lovingjn@gmail.com.
  4. Graduate School of Public Health, Seoul National University, Seoul, South Korea. hellotammy@snu.ac.kr.
  5. Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. mateus111@daum.net.
  6. Transplantation Center, Seoul National University Hospital, Seoul, South Korea. jcyjs@dreamwiz.com.
  7. Transplantation Center, Seoul National University Hospital, Seoul, South Korea. jwhamd@snu.ac.kr.
  8. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. cdw1302@snubh.org.
  9. Transplantation Center, Seoul National University Hospital, Seoul, South Korea. curie@snu.ac.kr.
  10. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. curie@snu.ac.kr.
  11. Department of Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea. imjung@brm.co.kr.
  12. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. yoonkyuoh@gmail.com.
  13. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. cslimjy@snu.ac.kr.
  14. Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. djhan@amc.seoul.kr.
  15. Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. skpark@amc.seoul.kr.
  16. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. yonsukim@snu.ac.kr.
  17. Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. kyh-001@hanmail.net.
  18. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. nephrolee@gmail.com.

Abstract

BACKGROUND Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.

METHODS We enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2-4, 6, 8-10).

RESULTS The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).

CONCLUSIONS The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

Figures

Fig. 1
Fig. 1 Defining the study population. We reviewed the medical records of 2425 individuals and collected data from 1348 patients
Fig. 2
Fig. 2 Kaplan-Meier curves of fatal/non-fatal acute coronary syndrome (ACS) and composite outcomes of ACS and death in patients with different MIA factors. a-b. The patients in the lowest albumin quartile showed worse ACS outcomes (p = 0.042) and composite outcomes of ACS and death (p = 0.016) than the others. c-d. The patients in the highest CRP quartile showed tendency of worse ACS outcomes (p = 0.106) and composite outcomes of ACS and death (p = 0.187) although statistically insignificant. e-f. The patients with previous history of vascular disease showed poor outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than the others
Fig. 3
Fig. 3 Kaplan-Meier curves of ACS, composite outcomes of ACS, graft outcome, and death in patients in MIA score groups. a-b. The patients with higher MIA score showed worse outcome of ACS (p < 0.001) and composite outcomes of ACS and death (p < 0.001) than those with lower MIA scores. c-d. Graft outcome and all-cause mortality were not different between the groups (p = 0.973 and p = 0.183, respectively)
Fig. 4
Fig. 4 Kaplan-Meier curves of ACS and composite outcomes of ACS and death in divided patients by previous history of vascular disease. a-c. In the patients without a history of vascular disease, ACS (p = 0.567) and composite outcome (p = 0.673) did not show significant difference according to the quartile value of albumin and CRP. b-d. In the patients with a history of vascular disease, ACS (p = 0.002) and composite outcome (p = 0.011) occurred more frequently in the patients in the lowest albumin + highest CRP quartile group than in the other patients

그림 출처: PubMed Central 공개 논문 (PMC4508766)

그 밖의 정보
출판 형태
Journal Article, Multicenter Study
저널
BMC nephrology · eISSN 1471-2369
전자 출판
2015-07-21
MeSH
Acute Coronary Syndrome / epidemiology / mortality · Adult · Aged · Atherosclerosis / epidemiology · Body Mass Index · C-Reactive Protein / metabolism · Cardiovascular Diseases / epidemiology / mortality · Cerebrovascular Disorders / epidemiology / mortality · Cholesterol / metabolism · Comorbidity · Female · Humans · Inflammation / epidemiology / metabolism · Kidney Failure, Chronic / epidemiology / surgery · Kidney Transplantation* · Male · Malnutrition / epidemiology / metabolism · Middle Aged · Mortality · Multivariate Analysis · Peripheral Vascular Diseases / epidemiology / mortality · Preoperative Period · Prognosis · Proportional Hazards Models · Republic of Korea / epidemiology · Retrospective Studies · Risk Factors · Serum Albumin / metabolism
Substances
Serum Albumin · C-Reactive Protein · Cholesterol
참고문헌
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