Document Detail


Long-term cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease patients after renal transplantation.
MedLine Citation:
PMID:  8291117     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with autosomal dominant polycystic kidney disease (ADPKD) have an increased incidence of hypertension and cardiovascular abnormalities. In this long-term follow-up study (5.88 years on average), we evaluated cardiovascular disease and patient and graft survival in 101 ADPKD patients and 692 nondiabetic control patients receiving cadaveric renal transplants between March 1967 and April 1991 at the Leiden University Hospital. Graft and patient survival was not different between patient groups, using the same immunosuppressive therapy. However, death with functioning graft, mainly due to cardiovascular disease, was significantly more frequent in the ADPKD patients than in controls using AZA (P < 0.01). Multivariate analysis of pretransplant data showed that ADPKD patients on AZA therapy demonstrated an elevated age-adjusted relative risk of 2.07 (95% confidence interval [95% CI]: 1.12-3.80) for cardiovascular events and 2.88 (95% CI: 1.41-5.90) for cardiovascular mortality alone. After adjustment for age, gender, and other cardiovascular risk factors, a relative risk of 2.39 (95% CI: 1.06-5.40) was found. This was 2.87 (95% CI: 1.04-7.93) when cardiovascular mortality was the dependent variable. With posttransplant data, the age-adjusted relative risk for cardiovascular morbidity and mortality in ADPKD patients using AZA was 2.16 (95% CI: 1.12-4.15) and 2.97 (95% CI: 1.40-6.27), with only cardiovascular mortality as the dependent variable. After adjustment for age, gender, and other cardiovascular risk factors, this was 1.59 (95% CI: 0.64-3.91) and 2.28 (95% CI: 0.79-6.53), respectively. With CsA treatment, an elevated risk for cardiovascular morbidity and mortality in ADPKD patients was present, but the corresponding 95% CI were wide and include unity, due to the shorter period of follow-up (CsA: 3.81 +/- 2.50 years vs. AZA: 7.28 +/- 6.74 years). Survival of ADPKD patients using AZA was less in those patients without pretransplant nephrectomy as compared with control patients, but the morbidity and mortality of pretransplant nephrectomies should be taken into account. We conclude that ADPKD patients show a similar graft and patient survival after renal transplantation as control patients, but they are especially at risk for cardiovascular disease after renal transplantation.
Authors:
K W Florijn; P C Chang; F J van der Woude; J H van Bockel; J L van Saase
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  57     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1994 Jan 
Date Detail:
Created Date:  1994-02-24     Completed Date:  1994-02-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  73-81     Citation Subset:  IM    
Affiliation:
Department of Nephrology, University Hospital Leiden, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cardiovascular Diseases / complications*
Female
Graft Survival
Humans
Immunosuppression / methods
Immunosuppressive Agents / therapeutic use
Kidney Transplantation / methods*
Male
Middle Aged
Multivariate Analysis
Polycystic Kidney, Autosomal Dominant / surgery*
Regression Analysis
Risk Factors
Survival Analysis
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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