Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies.

Abstract

Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint 'cardio-nephrology' clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.

• Authors: Janani Rangaswami, Roy O Mathew, Raviprasenna Parasuraman, Ekamol Tantisattamo, Michelle Lubetzky, Swati Rao, Muhammad S Yaqub, Kelly A Birdwell, William Bennett, Pranav Dalal, Rajan Kapoor, Edgar V Lerma, Mark Lerman, Nicole McCormick, Sripal Bangalore, Peter A McCullough, Darshana M Dadhania
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 34 Issue 5 Pg. 760-773 (05 01 2019) ISSN: 1460-2385 [Electronic] England
• PMID: 30984976 (Publication Type: Journal Article, Review)
• Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Topics

• Cardiovascular Diseases (epidemiology, etiology, therapy)
• Disease Management
• Global Health
• Humans
• Incidence
• Kidney Failure, Chronic (surgery)
• Kidney Transplantation (adverse effects)
• Survival Rate (trends)
• Transplant Recipients