Atherosclerotic vascular disease and its correlates in stable black South African kidney transplant recipients

Abstract

Stephen Olawale Oguntola,1 Muzamil Olamide Hassan,2 Raquel Duarte,3,* Therese Dix-Peek,3 Caroline Dickens,3 Gbenga Olorunfemi,4 Ahmed Vachiat,5 Graham Paget,1 Pravin Manga,5 Saraladevi Naicker1,* 1Department of Internal Medicine, Division of Nephrology, University of Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine, Dialysis Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria; 3Department of Internal Medicine Laboratory, University of Witwatersrand, Johannesburg, South Africa; 4Department of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; 5Department of Internal Medicine, Division of Cardiology, University of Witwatersrand, Johannesburg, South Africa *These authors contributed equally to this work Background: Despite remarkable improvement in renal function attributable to kidney transplantation, the burden of cardiovascular disease (CVD) among kidney transplant recipients (KTRs) remains high in the post-transplant period. Aggressive use of statins in KTRs may make lipoprotein ratios correlate better with atherosclerotic vascular disease (AsVD) when compared with traditional lipid profile parameters. We therefore evaluated the clinical and echocardiographic correlates of AsVD among non-diabetic, stable, black KTRs in South Africa.Methods: This was a cross-sectional study of 41 adult (18–65 years), non-diabetic, stable KTRs and 41 age- and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Urine and blood samples were obtained and analyzed. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed in both right and left carotid arteries. Spearman’s rank correlation and binary logistic regression were performed to determine the relationship between CVD risk factors and AsVD. Results: AsVD was present in 46.3% of KTRs compared to 17.1% of healthy controls (p = 0.004). Left ventricular hypertrophy was present in 92.7% of the KTRs. There were statistically significant differences in waist–hip ratio, systolic blood pressure, mean arterial pressure, urine albumin–creatinine ratio, serum fibrinogen, serum creatinine, estimated glomerular filtration rate, left atrial diameter, left ventricular mass (LVM), and left ventricular mass index (LVMI) between KTRs and controls. A positive relationship was seen between CIMT and certain risk factors for CVD including LVM, LVMI, and mitral valve deceleration time, (p < 0.001). ­Castelli index 2 and lipoprotein combine index (LCI) showed positive correlation with CIMT. On multivariate analysis, increasing age and kidney transplant status were independent predictors of AsVD after controlling for other risk factors.Conclusion: AsVD was common among KTRs. Older age and kidney transplant status independently predicted AsVD. Castelli index 2 and LCI correlated with AsVD better than serum lipid parameters. Keywords: carotid intima media thickness, lipoprotein ratios, Castelli index 2, lipoprotein combine index, left ventricular mass index 

Keywords

• atherosclerotic vascular disease
• carotid intima media thickness
• kidney transplant recipients
• lipoprotein ratios