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      The Impact of Living Donor Kidney Transplantation on Markers of Cardiovascular Risk in Chronic Kidney Disease Patients


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          Background: Kidney transplant (Tx) patients present a reduced cardiovascular (CV) mortality in comparison to the dialysis population, but in comparison to the general population, it is still several-fold higher. Methods: We studied risk factors for CV disease in a group of 38 patients (50% males, median age 36 years) who underwent a living donor Tx at the baseline and after 3 ± 1 and 9 ± 2 months. Results: The prevalence of overweight increased from 26 to 54% after Tx (p < 0.001). The mean systolic blood pressure decreased significantly after the Tx (148 ± 27.6 vs. 126 ± 12.7 mm Hg). There was a significant increase in LDL (97 ± 30 vs. 114 ± 35) and hematocrit (33.8 ± 4.4 to 42 ± 5.7%) levels and a significant reduction in fibrinogen levels (394 ± 91 vs. 366 ± 100 mg/dl) after 9 months as compared to the baseline. Obesity and dislipidemia were significantly correlated with inflammation. Significant changes in left ventricle mass index (293 ± 116 vs. 241 ± 96) were observed after the Tx. Patients with a low glomerular filtration rate (GFR) in the follow-up evaluation presented higher LDL (128 ± 7 vs. 99 ± 7 mg/dl; p < 0.05) and higher fibrinogen levels (399 ± 21 vs. 332 ± 22 mg/dl; p < 0.05) compared to patients with a high GFR. Conclusion: Most of the risk factors analyzed (particularly the uremia-related) improved after the renal Tx, which could justify the positive impact of Tx on the development of CV disease. Inflammation and dyslipidemia were related to renal dysfunction after the Tx, suggesting that complete restoration of renal function may have an impact on reducing CV mortality in CKD patients treated with renal Tx.

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          Relation between serum phosphate level and cardiovascular event rate in people with coronary disease.

          Higher levels of serum phosphate are associated with adverse cardiovascular outcomes, especially in the setting of overt hyperphosphatemia. Given the biological importance of phosphorus, it is plausible that higher levels of serum phosphate within the normal range may also be associated with adverse outcomes. We performed a post hoc analysis of data from the Cholesterol And Recurrent Events (CARE) study. Baseline serum phosphate levels were measured in 4127 fasting participants who were randomized to receive pravastatin 40 mg daily or placebo and followed up for a median of 59.7 months. We used Cox proportional-hazards models to examine the association between serum phosphate and adverse clinical outcomes after adjustment for potential confounders. During nearly 60 months of follow-up, 375 participants died. A significant association was noted between baseline serum phosphate level and the age-, race-, and sex-adjusted risk of all-cause death (hazard ratio per 1 mg/dL, 1.27; 95% confidence interval, 1.02 to 1.58). After categorization based on baseline phosphate level ( or =4 mg/dL) and further adjustment, a graded independent relation between phosphate and death was observed (P for trend=0.03). For instance, participants with serum phosphate > or =3.5 mg/dL had an adjusted hazard ratio for death of 1.27 (95% confidence interval, 1.02 to 1.59) compared with those with serum phosphate of <3.5 mg/dL. Higher levels of serum phosphate were also associated with increased risk of new heart failure, myocardial infarction, and the composite of coronary death or nonfatal myocardial infarction, but not the risk of stroke. We found a graded independent relation between higher levels of serum phosphate and the risk of death and cardiovascular events in people with prior myocardial infarction, most of whom had serum phosphate levels within the normal range. Given the ready availability and low cost of serum phosphate assays, this finding may prove clinically useful.
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            Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.

            Health-related quality of life (QOL) is an important measure of how disease affects patients' lives. Dialysis patients have decreased QOL relative to healthy controls. Little is known about QOL in patients with chronic kidney disease (CKD) before renal replacement therapy. The Medical Outcomes Study Short Form-36 (SF-36), a standard QOL instrument, was used to evaluate 634 patients (mean glomerular filtration rate [GFR], 23.6 +/- 9.6 mL/min/1.73 m2 [0.39 +/- 0.16 mL/s/1.73 m2]) enrolled in a 4-center, prospective, observational study of CKD. SF-36 scores in these patients were compared with those in a prevalent cohort of hemodialysis (HD) patients and healthy controls (both from historical data). QOL data also were analyzed for correlations with GFR and albumin and hemoglobin levels in multivariable analyses. Patients with CKD had higher SF-36 scores than a large cohort of HD patients (P < 0.0001 for 8 scales and 2 summary scales), but lower scores than those reported for the US adult population (P < 0.0001 for 7 of 8 scales and 1 of 2 summary scales). Patients with CKD stage 4 had lower QOL scores than patients with CKD stage 5, although differences were not significant. Hemoglobin level was associated positively with higher mental and physical QOL scores (P < 0.05) in all individual and component scales except Pain. SF-36 scores were higher in this CKD cohort compared with HD patients, but lower than in healthy controls. GFR was not significantly associated with QOL. Hemoglobin level predicted both physical and mental domains of the SF-36. Longitudinal studies are needed to define at-risk periods for decreases in QOL during progression of CKD.
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              Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program.

              Obesity is associated with increased single-nephron glomerular filtration rate, which may increase the risk for chronic kidney disease (CKD), especially when combined with hypertension. However, epidemiological data supporting an association between overweight and obesity and risk for CKD currently are limited. We used data from the Hypertension Detection and Follow-Up Program (HDFP) to test the hypothesis that overweight and obesity are associated with incident CKD in 5,897 hypertensive adults. Serum and spot urine samples were collected at baseline and year 5. CKD is defined as the presence of 1+ or greater proteinuria on routine urinalysis and/or an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 (<1.0 mL/s). In HDFP participants without CKD at baseline, the incidence of CKD at year 5 was 28% in the ideal-body-mass-index group, 31% in the overweight group, and 34% in the obese group. After adjustment for all covariates, including diabetes mellitus, mean baseline diastolic blood pressure, and slope of diastolic blood pressure, both baseline overweight (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05 to 1.41) and obesity (OR, 1.40; 95% CI, 1.20 to 1.63) were associated with increased odds of incident CKD at year 5. Similar results were noted after exclusion of participants with baseline diabetes mellitus, with both overweight (OR, 1.22; 95% CI, 1.05 to 1.43) and obesity (OR, 1.38; 95% CI, 1.17 to 1.63) remaining significantly associated with incident CKD. These results suggest that obese adults with hypertension have an increased risk for CKD.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                July 2007
                23 March 2007
                : 25
                : 3
                : 233-241
                aCenter for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, and bNephrology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
                101028 Blood Purif 2007;25:233–241
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 21 June 2006
                : 17 January 2007
                Page count
                Figures: 1, Tables: 5, References: 51, Pages: 9
                Original Paper

                Cardiovascular Medicine,Nephrology
                Chronic kidney disease, mortality rate,Cardiovascular mortality,Kidney transplant,Renal replacement therapy


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