#621 Dynamic assessment of cardiovascular risk factors in kidney transplant recipients

Abstract Background and Aims The incidence of cardiovascular diseases in patients with Stage 5 Chronic Kidney Disease is more than twenty times higher than in the general population. The aim of the study was dynamic assessment of cardiovascular risk factors in patients with chronic kidney disease in the preoperative period and after kidney transplantation. Method The study included 43 patients of the kidney transplant waiting list. At the time of kidney transplantation the average age was 45.3 ± 11.9 years; 53.5% (n = 23) were women, 46.5% (n = 20)—men. Patients were examined in the preoperative period, six months and five years after transplantation. Results The incidence of arterial hypertension was unchanged during the observation period, while episodes of hypotension in the postoperative period were diagnosed less frequently than in the preoperative period—4.7% (n = 2) versus 44.2% (n = 19), P < 0.001. Five years after transplantation, the average body mass index of recipients became higher and the incidence of obesity increased: 26.0 ± 4.8 kg/m2 versus 24.6 ± 4.2 kg/m2 and 25.6% (n = 11) 7.0% (n = 3), P < 0.01, respectively. The blood level of total cholesterol decreased only in the late postoperative period in comparison with the previous stages: 5.20 ± 1.09 mmol/l versus 5.91 ± 1.24 mmol/l and 5.70 ± 1.34 mmol/l, P < 0.05. Blood triglyceride levels decreased progressively: from 2.31 (1.58–3.37) mmol/l to 1.54 (1.16–1.94) mmol/l after six months and to 1.30 (0.90–1.80) mmol/l after five years, P < 0.05. The blood glucose level of recipients was comparable in the preoperative period and six months after transplantation—6.1 (5.5–6.3) mmol/L and 5.8 (4.5–6.3) mmol/L accordingly and decreased five years after transplantation—5.2 (5.0–5.8) mmol/l, P < 0.001, as the frequency of hyperglycemia did: from 44.2% (n = 19) and 32.6% (n = 14) to 11.6% (n = 5), P < 0.05. The average blood concentration of hemoglobin increased in the long-term postoperative period: from 108 ± 17 g/l to 125 ± 18 g/l and 127 ± 18 g/l, P < 0.001, and the frequency of anemia decreased from 79.1% (n = 34) patients in the preoperative period to 48.8% (n = 21) after six months and 34.9% (n = 15) five years after transplantation, P < 0.01. Transplantation also helped reduce the incidence of iatrogenic hypererythropoietinemia: from 27.9% (n = 12) to 4.7% (n = 2), P < 0.05. Dialysis patients had a high level of brain natriuretic peptide (NT-proBNP) in the blood—3300 (1800–3300) pg/ml. In the postoperative period it was significantly lower than in the preoperative period—175 (60–350) pg/ml after six months and 225 (60–500) pg/ml five years after transplantation, P < 0.01. An increased level of NT-proBNP was detected in all recipients in the preoperative period and decreased to normal values in 37.2% (n = 16) in the postoperative period, P < 0.001. Echocardiography showed no changes in ejection fraction and left ventricular myocardial mass index, the incidence of diastolic dysfunction: 64.4 ± 8.1%, 118.79 ± 43.93 g/m2 and 18.6% (n = 8) in the preoperative period versus 66.0 ± 7.5%, 117.32 ± 37.38 g/m2 and 11.6% (n = 5) in the long-term postoperative period, P > 0.05. The absence of negative changes in the structural and functional state of the heart for five years of observation in patients with chronic kidney disease can be considered as a positive stabilizing effect of transplantation. Conclusion Based on the study it was found that in the long-term postoperative period, compared with the preoperative period, kidney transplant recipients have a decrease in the incidence of hypotension, anemia, hypererythropoietinemia, an increase in body mass index and blood hemoglobin concentration, a decrease in the blood levels of total cholesterol, triglycerides, glucose and NT-proBNP, as well as stable the structural and functional characteristics of the heart.