Cardiovascular risk factors in pediatric kidney transplant recipients

Abstract

Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiovascular disease remains one of the most common causes of death in children and young adults. The authors performed a comprehensive analysis of cardiovascular risk factors before and after kidney transplantation. Methods: Retrospective study, from 2007 to 2017, that included children and adolescents with a minimum of six months follow -up after kidney transplant. Demographic profile, chronic kidney disease characteristics and family and personal cardiovascular risk factors (hypertension, left ventricular hypertrophy, anemia, overweight/obesity, dyslipidemia, hypoalbuminemia and new onset diabetes after transplant) were assessed. Pre - and post -transplant cardiovascular risk factors were compared using the McNemar test. Results: We included 49 patients, with a mean age at the time of transplantation of 9.3 ± 4.2 years. Congenital anomalies of kidney and urinary tract (37.7%) and glomerulopathies (32.7%) were the most frequent causes of stage 5 chronic kidney disease. Transplantation was preemptive in five patients. Living donor transplant was performed in six cases. The immunosuppression regimen was identical in all patients and there were nine acute rejection episodes. The most frequent pre -transplant cardiovascular risk factors were dyslipidemia (90.3%), hypertension (70.8%) and anemia (61.9%). After transplant there was a decrease of all cardiovascular risk factors except for overweight/obesity. Although a better control of hypertension was granted, the decrease was not significant. Hypoalbuminemia and dyslipidemia decreased from the 6 -month evaluation on (p<0.001) and left ventricular hypertrophy and anemia from the second year on (p<0.05). Conclusions: We aimed to evaluate the evolution of cardiovascular risk factors in pediatric patients before and after kidney transplant. In our cohort there was a decrease in all studied cardiovascular risk factors after kidney transplant, except for overweight/obesity. This could mean that chronic kidney disease related factors decrease with time, but traditional risk factors may persist or increase, and need active prevention.

Keywords

• cardiovascular diseases
• heart disease risk factors
• kidney transplantation
• pediatrics